nurseXY

Christmas Eve & The End

2012-01-02T20:49:00.003-06:00

Likely this will be the last post here on NurseXY. I haven't written in awhile, and rest assured it's not because I haven't had ample blog fodder. In fact, it seems that every single shift I work offers up at least one or two events that seem blog worthy. So much so that I find myself realizing that if I blog about one situation, 3 or 4 more are just as pertinent.

I suspect that this is simply the nature of nursing. Or at least nursing on my unit, and it's time to get over myself and my nursing experience. Likely you as RN's (or other medical professionals) have the same experiences. Mine aren't any more valuable.

A few have emailed checking to see if I am ok, so a small update: I am now on day shift, have been since back in June or July. Day shift on our unit is nuts. I've never worked so hard in my life. But this is good, I don't (can't) get lazy. I enjoy getting regular admits from the OR, and I enjoy interacting with physicians on a daily basis. (They are amazingly friendly when you aren't calling them at 0200!) I've managed to develop a bit of a positive reputation with a few of them even. Recently, after hearing my name called on the overhead PA requesting help for about the 10th time that morning, a patient of mine commented, "Boy they'd be a little lost without you, wouldn't they!?" It was a truly meaningful compliment. And I feel like I pull more than my weight.

Life isn't all roses though. I have trouble with my manager--I'm relatively sure that she's a large reason why the unit has many of the issues it does. I tend to be outspoken, and I tend to emphasize the things that truly matter (like patient care, patient safety etc) and let the bureaucratic things slide. Unapologetically. Not terribly popular with management.

Regardless, as I come to the end of this blog here, I thought I'd like to leave you with one last post, and a positive one at that.

I was scheduled to work on Christmas Eve and Christmas Day this year, and Christmas Eve's shift was nutso. The entire day was ridiculous, and doing a bedside surgical trach revision at 1825 (20 minutes before shift change) pretty much was the cherry on top. Needless to say, I was late leaving and there were very few vehicles on the road as I drove my 42 miles home in the clear, cold darkness. As I passed through a particularly rural portion of my drive, my thoughts couldn't help but wander to the Christmas story of the shepherds tending their flocks that first Christmas Eve so long ago. And I as I reflected, I began to see a parallel with the shepherds in the fact that I was out and about in service of others in need while most people were safely snug at home.

And it was then that I realized, all those people with food in their bellies, a warm home wrapped around their shoulders like a coat of contentment? They would have completely missed Christ's birth. Their feet would have been comfortably propped by the fire, telling stories or playing some silly card game.

As the story goes, not so Joseph and Mary. They ended up in a stable because they were in desperate need, and a humble barn was the best they could scrounge--offered only as a second thought.

If Christ had been born in 2011, on some tattered greasy couch in some mechanic's shop in the slum of some city, who would have been there to witness it? To welcome God incarnate? The well to-do? The church goers at Christmas Eve service?

So my thought is simply this: it is where service and human need come together that the spirit of Christmas can truly be revealed and we can experience the face of God.

Merry Christmas, and may God bless us, everyone.

Sincerely,

Robert Fenton RN-BSN

Where Has All The Goodness Gone?

2011-10-28T22:55:00.002-05:00

Alone.

At home in the living room.

Kids in bed. Wife at work.

And I'm searching for the good. The TV is on--an episode of HouseHunters International. A woman is moving to Paris after battling Stage 3 breast cancer and losing her husband over the last year.

She's looking for the good.

When the show is over, she's happy in her new apartment in a beautiful, romantic city.

My eyes scan the shelves of movies we own, and come to rest on "The Sound of Music". It doesn't get much more good than that. My mind examines why this is? It was a time when there was a definite line in the sand. On this side was the bad. On this, the good. One was the enemy, or not.

70 years later it looks pretty black and white.

But what if the enemy is within?

Where has all the goodness gone?

I live in a comfortable home--a dream completely out of reach for many. Yet I want to move. I long to live in another place. Anywhere but here, really.

I have a job--the deepest desire of many. It used to afford me moments of joy. Delight in saving lives. But now I struggle to tiptoe through each shift worried more that I will do something that will get my hand slapped, or worse.

I am married--and so many are so alone. But I struggle to maintain even the simplest lines of communication. The specter of my insecurities and past hurts and grievances shadows over all.

I have kids--while so many are desperate to bear children of their own. One child that no longer wants to live with me. And my bearish tendencies and low patience threshold send the other two to my wife's welcoming arms.

I feel so very grey.

Where, oh where, has all the goodness gone?

Alone

2011-10-27T21:01:00.001-05:00

"We're born alone, we live alone, we die alone. Only through our love and friendship can we create the illusion for the moment that we're not alone."

--Orson Welles

Perspective

2011-10-18T10:37:00.000-05:00

Sunday I worked--another insane shift, and another insane assignment. But that's another post.

I was assigned to our reverse isolation pod where we put our heart and lung transplants. I was assigned two very sick transplants with complications, but across the pod was a fresh lung transplant from Friday. When I came on shift he was doing pressure support trials in preparation for extubation. He was pretty anxious--as most people intubated without sedation are--but even more so because he was a lung patient.

He passed his trials with flying colors and was quickly extubated. His family came in afterwards, thrilled to be able to talk to him. The family was bubbling over with happiness and enthusiasm, which is pretty typical of post transplant patients and families. They are just so thankful that their loved one has been granted a second chance afforded them by their new organs.

The patient was doing his best to match his family's mood, but it was pretty clear to me that he wasn't doing as well as he was making out. His wife kept asking him if he felt better, and he would agree that he did, managing a tentative smile for her.

He was a little more forthcoming with his nurse when the family wasn't present. He admitted to some pain and feeling somewhat short of breath. He also was pretty fatigued. Most of all he was just tired of being in a hospital bed with all the ridiculous lines and tubes we insist on attaching. And rightly so I think--we do tend to take things a little far with what we expect our patients to tolerate. He had come to our hospital from 750 miles away for the transplant consult, and it had taken 10 months to get where he was because of some other complications that needed to be resolved before he was a true candidate. Imagine being away from home temporarily...but for 10 months. Did I mention we don't have TV's in our open pods? In short, he was just cranky.

A couple hours later I overheard him ask his nurse how much of the surgery he would be awake for. I stopped what I was doing to look across the pod and listen in.

The nurse gave him a blank look and asked, "What surgery?"

A little annoyed, he shot back, "The one I've only been waiting 10 months for!?"

"Uh, you had your surgery on Friday, today is Sunday."

His turn to give a blank look.

She repeated, "You got your lungs on Friday, you've had your transplant already."

"No shit??" A slow smile spread across his face.

Thanks to the anesthesia the last thing he remembered was changing into a gown...

It's amazing to see the shift in his perspective and his mood based on that one small piece of information. Suddenly he was pleasant, jovial even. He was happy to see his family, even when they stayed to long, or asked him for the 50th time, "How do you feel? Are you better??"

So let me ask you, when you woke up this morning, did you face the day like it was gift? Like you had been blessed with a new set of lungs?

Or are you still waiting (for 10 months now!) for something good to happen?

If I may draw from the wisdom of Frog on the kids show Little Bear, (a favorite in my house), "A day is just a day. It isn't good or bad." We decide if it's good or bad.

What will you do with your new lungs today?

You Might Be...

2011-10-15T10:19:00.002-05:00

You might be a nurse if:

You start a vitals/medication flowsheet at home when a family member is ill...

Pay Day

2011-10-14T09:25:00.000-05:00

My wife and had a financial meeting this morning, as we often do on the morning after our paychecks get direct deposited into the checking account. Usually it's a quick assessment of what little we have to show for our hard work after the dust clears from the bills feeding frenzy.

Today was no different.

However, we did a quick check of our gross income to make sure that we were on track with our tithe amount for church. And that's when it hit me.

My gross pay for the year (with numerous extra shifts and overtime) was just over half of my wife's gross pay to date. Right at 55%. My wife doesn't often work extra shifts (although she has occasionally.)

Let me qualify this observation:

a.) She has been at her job for 9 years, I for less than 1 year.

b.) She works a contracted weekend plan that pays her an extra differential for working every weekend.

Ok, so she's had a significant head start, and she gets compensated for forking over our social life essentially.

But twice as much? Really??

She works for a nationally recognized non-profit children's hospital. It is a large hospital--over 300 beds, and expanding even as we speak. It is a designated trauma center. She works on a critical care unit at the highest level of care provided by the hospital to its patients.

I work for a nationally recognized non-profit hospital. It is a large hospital--over 1000 beds, and expanding even as we speak. We are designated a Level 1 trauma center. I work on a critical care unit at the highest level of care provided by the hospital to its patients.

New grad nurses at her hospital make on average at least $10,000 more per year than new grads at my hospital.

My wife gets paid extra for working in critical care. I get paid the same as any other nurse in the hospital--day surgery to med-surg to L&D. We all get paid the same.

I recently remember working a weekend (extra diff), night (extra diff), holiday (time & a half), overtime (time & a half) shift. After adding up all my diffs and overtime, my hourly pay was only slightly more than my wife's base pay.

I don't mind that my wife makes more than me, at least not consciously. In fact I'm quite thankful as her job is the only way we've survived financially through my job failures and extra degrees. But when I think about how hard I work and the razor edge I routinely walk with my patient's lives and my license, it is a little disheartening to see the disparity. I don't think my wife works any less hard than I do, but I don't think she works any harder either.

Because of my past degrees, I have a crippling amount of student loan debt. Two of my three loan payments were more than this 2 weeks paycheck, and the third loan payment will be another 1/3 of my next paycheck. Lucky for me, the end of those payments is in sight--only 29 1/2 years from now.

I guess like many, I'm lucky to have a spouse willing to lump her paychecks into the joint checking account to provide for her family.

So sweetie, "Thank you," for paying my car payment this month, and my insurance, groceries, and fuel. Oh and "Thanks" for providing me a place to live.

I'll do my best to repay you when I get my earning potential soul back from the student loan companies.

Either that or when my life insurance comes through.

If It Isn't Charted...It Never...

2011-10-12T21:20:00.005-05:00

...happened.

I generally regale you, my faithful readers, with stories of my wild successes. Usually I play the distinguished (if not a little crusty) hero with some great over-arching theme to impart upon the nursing masses.

Not today.

Today I was called into the office for a closed door conference with the unit educator and the unit manager. The door closing behind you is pretty much a fateful sign. You're not escaping without some pound of flesh taken in payment.

All this over a shift that was an ass-kicking from the start. Two very sick patients--one in severe septic shock, and the other most likely in the same situation. One was on hemodialysis, the other on CVVHD. A handful in and of itself, but across the pod lay a 180 kg woman who was to be taken for a CABG. Only the night shift nurse had pulled the PCI sheath, held pressure for 4 minutes flat, determined the patient wasn't bleeding externally from the site, and called it a day. It wasn't much later that the patient developed a football sized hematoma. That grew to be basketball sized while her pressures cratered from the shock of it all. Not hard to do when your ejection fraction is <15%.

Meanwhile that patient's nurse was chasing herself silly trying to get her other patient transferred to the floor because the first case of the day needed to go into that bed for staffing reasons. As in, we didn't have staff to take that case. When she left to transfer her patient, I was tasked with watching her other patient's hematoma grow.

I was left to doppler distal pulses and set up a C-clamp to hold pressure on the femoral artery to prevent the hematoma from growing any bigger. All the while maintaining some semblance of hemodynamic stability. I had just turned the patient's levophed up to our unit's max dose to maintain a pressure in the 60s (nothing like squeezing a dry tank, right!?!) when my patient on hemodialysis bottomed her pressures in response to the fluid draw. So away I went to titrate some pressors to maintain a MAP above the renal injury threshold. Just as I was about to get her settled, my CVVHD patient clotted her filter. And it was while I was attempting to rinse back the 200+ mls of blood in the machine that the anesthesiologist and anesthesia tech appeared to take hematoma lady to the OR.

It was a dangerous situation. Did I mention my charge nurse was off the floor kissing Joint Commission ass with the manager--we were being recertified for LVADs you see.

I had no help.

I spent the rest of the shift trying to catch up on my charting while taking care of two still very sick patients. Towards the end of the shift one of my patients began breathing at a rate greater than 50. She was intubated, but not sedated, and pressure support CPAP-ing. (Recipe for disaster really since we were not about to extubate her...)

My calls to physician essentially fell on deaf ears. I received orders to increase the pressure support, but nothing else. I complied, and at shift change the patient wasn't doing much better.

In my rush to get home to take over care of my children from the babysitter, I neglected to chart my communications with the physician. (And somehow went an entire shift without charting vent settings!? Facepalm! WTF??)

And the night shift nurse took exception to the hot mess I handed her and promptly tossed me under the bus.

Fade to employee conference. I sat in my seat while my manager and educator talked down to me, asked me loaded questions in the most condescending tone they could muster, and basically held my nuts to fire...

Because I screwed up and didn't document.

So in the meantime, I've been banished to "the garden" to take care of chronic patients.

There are so many things wrong with the way I was treated that even now I get tears of frustration thinking about it.

BUT.

Kids, remember this.

If it isn't charted.

It. Never. Happened.

You Might Be...

2011-08-03T17:56:00.000-05:00

You might be a nurse if:

You've signed a check with your name...and RN.

You Might Be...

2011-07-29T19:19:00.000-05:00

You might be an ICU nurse if:

Your measurement of time is "minutes until it's time to write vitals."

I Just Don't Know

2011-07-26T07:40:00.000-05:00

Lately I've been contemplating the direction I'd like to take this blog.

The longer this space exists, the chances of my true identity being unmasked grows, possibly exponentially. When I started this iteration of my blog, I had no idea that it would grow to be even as mildly popular as it has. I wasn't clear sighted enough to plan for that from the start. As a result this "anonymous" blog is hopelessly entangled with my "real" life.

For instance, the master email Blogger associates with this account happens to be my gmail account that I use for *everything*. Not a big deal because that email address isn't used anywhere except for me to sign in. Nicely compartmentalized I thought. Only when somebody sends me a Google+ invite, suddenly my Picasa account (with all my blog pictures) will be linked to my uber-Facebook experience. And suddenly my real name will be substituted where my nicely anonymous username had reigned. Blast it.

I can't say that it isn't tempting to exit the proverbial blogging closet, and just become a real person in both senses. But that would pretty much preclude any patient stories no matter how fabricated. And frankly, do I have enough important things to say regarding nursing that people will continue to visit without the sensationalism of my patient encounters?

Am I ready to give up the sanctity of my virtual repository to unload and get things off my chest?

I just don't know.

At some point I'd like to transition my writing to more mainstream outlets. Does an anonymous body of work allow for that?

"I'd send you examples of my writing...except I can't...you know patient privacy and all. I write real good though. I swear."

I just don't know.

A Different Kind Of Crazy

2011-07-24T19:13:00.001-05:00

Amongst my least favorite patients to care for are those that have lost their noodle. Be it dementia, ICU psychosis, mental illness, it just wears me out having to deal with them.

I like logic. I like things to be orderly. I like it when people have been educated, and the information leads them to draw the conclusions I intend.

Crazy people don't do that. And that cuts across the grain of everything that makes my purplish haze of a world tolerable.

But I ran across a new kind of crazy this week at work.

This lady, (let's call her Eleanor), was 100% with it. She was completely lucid, she truly was that ever elusive A&Ox4. This is quite an achievement considering she'd come in for a valve replacement over a month ago and ended up with a CABGx5 and a balloon pump. Following her surgery, she rode our carepath upstairs only to come crashing back down as an RRT in respiratory stress.

It seems that the yahoo techs on our stepdown floor *still* cannot get it through their thick skulls that if a patient drinks too much water, with all the fluid shifts from being on pump, the patients drink themselves straight into pulmonary edema. Not to mention the atropine given pre-anesthesia makes *everyone* wickedly thirsty, for *days*. So when the techs get tired of answering call bells about drinks of water, they sure as heck will bring the patient a big huge pitcher of water and let them drink themselves into a gurglely, pink frothy mess.

So it was with Eleanor.

And she ended up re-intubated. Then extubated. Then re-intubated, and extubated yet again. If you've played this game before, you know that each subsequent re-intubation significantly reduces the chances of a favorable outcome. Counting her surgery, Eleanor is working on post-extubation #3. Even now after spending 8 hours each night on BiPAP, her PCO2 is routinely greater than 65 each morning.

She's also failed her swallow study 3 times now.

All this to say that Eleanor is *strictly* NPO.

She knows this.

And she knows why.

And she knows the consequences of noncompliance.

But this does not stop her from asking, begging, pleading, groveling for a drink of water as many times an hour as you are willing to entertain. She actively tries to deceive anyone who comes near her bed and trick them into giving her water. She tries to split staff and family members and play them off one another to manipulate them into giving her water.

Honestly I've been around better behaved toddlers. (Two of which happen to live with me.)

Really I'm at a loss to adequately convey the sheer, colossal, unbelievable stupidity of it all.

I performed impeccable oral care hourly to maintain her oral mucosa. But my reward for this above and beyond (unit policy and procedure is Q4)? Each swab is met with a greedy demand, "MORE!!" Upon refusal, she throws anything within reach on the floor in protest. Pillows. Blankets. Her Bairhugger nozzle. You wouldn't believe how low my bullshit tolerance for this kind of shenanigans is.

Maybe a better, more saintly nurse would have had the patience to deal with these outbursts. Me, with my curmudgeonly tendencies, simply didn't give the items back to her the second time they ended up on the floor. When she started immediately sucking the water out of each swab (nearly aspirating on that small amount of water each time) rather than letting me wet her mucosa, I promptly switched to using chlorhexidine gluconate instead. Funny, she was much less enthusiastic about her oral care after that.

On my second night taking care of her my frustration came to a head. My other patient, a fresh pericardial window was starting to act pretty sick. He was bradying down into the low 40s, and I had no pacing access other than transcutaneous pads on the crash cart. His pressure was dropping from 160's systolic on 5 mcg/kg/min of nipride, to a systolic of 90-100 with the nipride on standby.

In the middle of this, Eleanor started demanding water. Yelling, cussing, cajoling. Saying idiotic things like, "Just pour it on top of me, I don't even have to drink it. Just pour it all over me." When nobody was paying attention to her, and there were several of us in the room because of my other patient, she ripped her BiPAP mask off and threw it across the room.

I'd had enough, and as I was putting her mask back on, I kind of lost it on her.

"You need to *stop* this. You are a *grown woman*, you need to start acting like it. You are embarrassing yourself and your family by the way you are acting. My other patient is extremely sick right now, and instead of being able to help him like I should, I'm here, dealing with this foolishness."

In a poetic cinematic world, she would have realized how silly she was being, become remarkably compliant, if not apologetic. Then she would have written letter to the administration about the incredible life-saving care she received, highlighting each of the nurses she had.

In the real world, she pulled off the biggest 2-year-old pouty-lip I've ever seen.

But at least she was quiet.

You Might Be...

2011-07-22T09:17:00.000-05:00

You might be a nurse if:

Before taking ibuprofen for body aches or headache, you automatically try to code the barcode for documentation...

25 Best

2011-07-21T17:16:00.000-05:00

It seems nurseXY has been selected as among the 25 best nursing blogs by David Gurevich over at QI Exam Prep.

Pretty heady company he's put me in with, I'm not sure I quite belong. However, I appreciate the recognition.

Thanks David!

P. R. N-competence.

2011-07-20T12:45:00.005-05:00

So I started working PRN at the ICU where I did my externship. I'll be working 4 shifts a month, which works out to one a week, but it's nice in that I don't have to work them that way, I can clump them if I like.

It works well since the hospital is about 10 minutes from my house, as opposed to 45 minutes minimum to my other job. It also works well considering I have only 6 months experience, 3 1/2 months really if you look at my experience since coming off orientation. Most hospitals around here won't even glance at you until you have one year plus at least. My manager had to go to the CNO to get me approved. It's nice to have people willing to go to bat for you though.

One thing I've learned quickly though in my short career thus far is that experience doesn't necessarily equal competence. This has been vividly illustrated to me a couple of times recently.

This past week I sat through hospital and nursing orientation, (again) at my new job. Part of that orientation process involved a pair of EKG exams. The first of these exams was 15 questions long, but only the 4 lethal rhythms held any point value--25 points each. The other 11 questions weren't worth any points--information not announced to us, but readily available because the computer displayed point values for each question during the exam. The lethals were not difficult. Predictably there were strips showing asystole, v-fib, and a couple v-tach (one even a torsades, but that wasn't even an option to be picked.) Not rocket science, not tricky.

The nurse next to me there in orientation had been quite vocal about her 1 1/2 years of big-time experience at an ED in a medium-size town about an hour away from our metro area. She unfortunately failed the lethal EKG exam. Studied for 30 minutes, and promptly failed it again. Now she has to complete an EKG/Dysrhythmia course, just to keep her job.

Secondly, my wife is currently precepting at work. Her intern is a nurse with 18 months experience up on the floor and transferred into the PICU. But this nurse lacks basic skills like passing meds on time. She's been sent to a couple codes, only to stand around and watch. Even tasks such as recording vitals appears to be beyond her skill-set. In fact, it seems what she's demonstrated she's best at is letting the PICU nurses know, "That's not how we do it on the floor..." The scariest part of this situation is that she's already started her acute-care nurse practitioner program--online of course.

So on behalf of all us with less than that magic bullet of one year's experience... I rattle convention's cage!

You Might Be...

2011-07-18T20:16:00.002-05:00

You might be a nurse if:

When using the restroom you automatically reach for gloves before wiping...

Up In The Air

2011-07-07T22:05:00.006-05:00

Life is up in the air right now.

I have no real focus, and I'm really unsure what direction to proceed.

My original plan was painfully simple. Go to nursing school. (Check.) Graduate and get a job on the biggest, baddest ICU around. (Check.) In two or three years apply for CRNA school and get on with life. (.....)

Muddying circumstance #1:

This lovely president of ours, Obama, enacted legislation that dictates those that make 10 years of payments on their federal student loans while working in a public service capacity, will have the remaining balance of their federal student loans forgiven. RN's definitely qualify as long as they work for a not-for-profit organization, which I currently do. Interesting tidbit: Nurse Practitioner's qualify, CRNA's do not. After doing the math, this loan forgiveness could total as much as $200,000 in my case... Market analysis of compensation for NPs shows that the gap between CRNAs and NPs is starting to narrow. In short NPs may soon be making the kind of salary reserved previously for CRNAs.

Now consider that the cost of the CRNA schools in my metro area both top $75,000, while NP school falls under the category of regular graduate school. CRNA students are prohibited from working during school (in fact both schools here will kick you out of the program, no questions asked, if they catch you working.) NP students at local schools do not have any such restrictions. And here's the kicker--the tuition reimbursement program at my current hospital *almost* covers the tuition for graduate school. They also have a TDA (Two Day Alternative) program where employees work Saturday-Sunday every week--two shifts, but keep full time status and benefits, and earn an extra differential that approximates working three shifts instead of two--that would allow me to go to school full time during the week.

The nursing school I graduated from has an Acute Care Nurse Practitioner program...

Thinks that make you go hmmm.

Muddying circumstance #2:

My wife and I have been fortunate enough to have her younger sister living with us to watch our kids while both of us work night shift. This allows us to work as many shifts together as possible, allowing us to have days off together. However, that situation will be changing. I'll spare you all the drama and gnashing of teeth, but rest assured it hasn't been a pleasant situation with frustrations ranging from not being available when we were counting on her, to wondering about our kids safety while in her care.

The nice thing about working as nurses is that we only work 3 days a week, so it *can* be done not needing childcare at all. But that means that we will only have one day a week off together, and really because of the logistics of night shift, it means that we'll have two half days off rather than a full day.

We are exploring options that include me moving to day shift to cut down on the daycare needs, but that also requires me transferring to another hospital within the system since my wife and I work on opposite ends of the city currently. And that means leaving my beloved CVICU...

Muddying circumstance #3:

I have been dying to get out of this town since I got here (state, really). The summer heat/humidity kills me. I crave seasons. I crave snow. I crave being able to spend time outdoors without melting into a puddle on the blistering concrete or triple digit asphalt.

I began researching grad schools in other parts of the country, and have been very, very attracted to Duke. I love the idea of a big name school. I love that the hospital is next door to the school. I love that the hospital has a program for employees that pays up to 90% of your schooling in exchange for contract on graduation... I love the idea of North Carolina, where the average high temperature in the summer tops out in the low 90s... I love that North Carolina is a Nurse Licensure Compact state... I love that Duke has one of the few Pediatric Acute Care Nurse Practitioner programs in the country...

Aauugggh! My brain hurts!

By Faith, Not By Sight

2011-06-28T09:06:00.000-05:00

A large man by anyone's standard, he was much more than overweight. He was tall and heavily framed, with a broad face and meaty hands. Still though, he carried probably close to 75 lbs extra with him wherever he wandered. By all accounts this mountain of a man was immovable, unconquerable, invincible.

That is, until he went to the dentist.

It was a simple extraction, nothing so involved as a root canal or other oral surgery. And it took no more than 15 minutes from needlestick to lollipop unwrapped from the cheery mug on the counter, meant to soften the blow of paying for often painful services at the payment window.

Even as he lumbered out the door, pausing to hold it open for a harried mother with three small children in tow, he had no idea.

He had no idea he was already dead.

A few weeks later, he had been ill for more than a week. He passed it off as being fatigued from the busy season at work, but his wife knew better. That was his way though, shrugging off illness like a bull swatting a horde of biting flies with his tail. But when he began talking out of his head, making incomprehensible requests and becoming severely agitated when she couldn't make heads or tails of it at all, she ran for her cell phone to call 911. Likely that saved her from injury as well, for as soon as she left he had gathered himself unsteadily to his feet and promptly collapsed onto the oak and stained glass coffee table, flattening it and sending shattered leaded glass whistling through the air like so many pieces of brightly colored shrapnel.

Arrival at the ED found him in dire straights indeed. The 12 lead EKG in the ambulance on the way in showed massive ST elevation, but his clear stroke-like symptoms described by his wife were also particularly troubling. The monitors barely registered a blood pressure. The impressive array of superficial cuts from the coffee table that seeped and oozed blood were by far and away the most visible sign of trouble, but were the least concerning. At least until the removal of the particularly large fragment in the middle of his chest began bubbling black purulent blood like black gold oil flowing out of the ground in West Texas.

The final tally of CT's and other tests read like a cheap Saturday night horror flick. An abscess in the sternum had carved out its own living quarters, eroding into the aortic arch and front face of the heart. This did little more than expose the massive biological vegetation growing throughout both ventricles and atria.

Clearly a large fragment of this vegetation is what caused the massive stroke that strangled the life from half of the cerebellum, and most of the occipital, temporal, and frontal lobes on the left side of the brain. Unmercifully the mid brain and brainstem were spared, allowing bodily function to continue. And just to make life interesting, he was in massive septic shock, which had taken out most of his gut and kidneys.

A semi truck would have caused less damage.

And that's how I met him--recovering him from the 16 hour surgery to replace his aortic arch and bypass the 5 coronary artery blockages, and to reconstruct as much of his mediastinum as possible. He was on the ventilator, IABP, CVVHD. He was maxed on 4 different pressors, barely maintaining a MAP greater than 50. Chest tubes sprouted from every possible sector of his chest, draining foul black sludge from his tortured body. His urine, less than 20 mls of it per 12 hour shift, was black as well.

No other hospital in our area would have done this operation.

And through it all his beautiful family persevered. Stealing 5 minutes at a time during lulls of activity to pray over him, and gracefully stepping back to allow us to continue our care. Remaining sweet and grateful, thanking each nurse, each physician for caring for him as they left his bedside. Speaking words of encouragement to the other three patients and their families in the pod (none of which nearly as ill as their own loved one). Undeniable, unbridled, impossible faith.

I found myself in a moral dilemma. Every ounce of my medical knowledge told me that this man would not, could not survive. This knowledge demands of my ethical standards to keep my patient's family informed, albeit with caring and sensitivity, but a *realistic* picture. I simply could not live with myself if I created a false sense of hope for someone.

But this family's faith is contagious. Do I dare hope against glimmer of hope that a miracle happens? Is it my duty to battle this unrealistic shred of sanguineness?

I carefully, lovingly even, kept the family up to date regarding his condition. I could tell they were firmly grounded. They knew and understood the severity of his condition.

After one such update to his wife, I found myself apologizing to her for not being able to fix him for her.

Resting her hand momentarily on my arm, her tired eyes sought mine and smiled a quiet, knowing smile.

"Right now," she said, "We're walking by faith, not by sight."

Re-Emergence

2011-06-22T15:01:00.003-05:00

Perhaps it's just been a break to catch my breath. Perhaps memorializing everything in black & white electrons here on this blog meant I had to sort through and deal with everything that's been going on--which I just didn't want to do. Perhaps I've just been lazy.

I don't know.

But here I am, first post in nearly a month. I'm not sure where to begin, but I'll try.

In short, my depression came raging back, despite the SSRI I've been taking. I'm fairly certain it's probably because I just quit running cold turkey. My trip to the Grand Canyon (although a life altering experience) injured my knee making it very difficult to run without pain. Add the insane schedule of my internship, and the thought of a painful gym session was much less than appetizing. Or maybe depression just does that--returns without invitation to steal away joy for no reason at all, to just laugh its evil giggle while I foundered and gasped and struggled.

Regardless the reason, I slipped again into the deep, dark pit of loathing. My wife disengaged because it's easier to get wrapped up in kids and work than deal with an embittered bastard of a husband cloaked in the throes of desolation. My kids were driving me up the wall. Church ceased to salve my soul. My friends disappeared because I was always working or sleeping. Work sucked, but amazingly it just sucked the same amount and actually became relatively tolerable.

The breaking point came the night that I had an extremely vivid dream where I awakened in an unknown place. By the time I pieced things together I realized I had been committed to a mental health facility. As I lay there trying in vain to orient myself, mind befuddled in a medication hangover, my wife appeared in the doorway.

Cheerily she said, "Oh great! Look who's awake!"

My relief in seeing a friendly face was quickly replaced with abject horror over the realization she was there as an employee, not as a wife. She actually worked on the unit.

I was then accused of sleeping with my "hands under the blanket, again", with a knowing shake of the head. She left the room as I lay there trying to understand what that could possibly mean, why it was bad, and how I could prevent myself from putting my hands under the blanket while I slept...

I followed her from my room into the large common area to discover her sitting at a table with the other nurses, chattering away and laughing at some unheard story of levity.

The dream was wrong in so many ways, and couldn't happen in real life, but I cannot even begin to express the vividness of the dream or the feeling of betrayal...

Regardless it galvanized me to action, and I began taking double the dose of my SSRI, and now a couple weeks later, things seem to be smoothing out a bit. I'm not sure what I'm going to do when my 3 month supply is gone in a few weeks rather than a few months.

I need to return to exercising, but I'm finding it difficult to force myself.

Anyway, I'm back. Thanks for all the concern. I hope the next post won't be quite so long in the making.

Missing In Action

2011-05-28T07:53:00.001-05:00

I'm still here. I think.

Work has been mostly ok.

Everything else has been a little rough.

Bathos

2011-05-04T09:23:00.005-05:00

[bey-thos, -thaws, -thohs]–noun, 1.) a ludicrous descent from the exalted or lofty to the commonplace; anticlimax.

Throughout my internship I was often given the most difficult patients on the unit. And as I blossomed from a fragile seedling root-bound in a plastic sprouting tray to a plant hardy enough for transplant, my preceptors stepped further and further back, allowing me to manage my patients, my way, developing my practice. At the end I was virtually on my own as my preceptors often were called to fulfill other functions on the unit.

And I did well. I managed some truly tough assignments, and my patients were the better for my care. I admitted countless CABG's. And those turned into redo CABG's, or extremely sick CABG's. And then it was IABPs, and LVADs, and impellas, culminating with admitting heart transplants and double lung transplants. On my own.

My unit and my internship experience turned out to be everything it was advertised to be. I was excited when I came off orientation to be on my own, ready to save the world. Or at least whatever train-wreck heart surgery came out of the OR suite that day.

Our unit is very busy right now, and higher acuity patients than usual. Right now we have 2 double lungs, 2 heart transplants, 2 LVADs, and an impella. One of the heart transplants went on ECMO yesterday, and there is another heart transplant, and lung transplant scheduled for today. This is on top of the run of the mill CABGs. 21 beds, 21 patients.

With all this glorious acuity, for the past 3 nights I've been assigned...

**drumroll please**

A blind VAT with cancer, on the unit for 33 days because he has a creatinine of 7.5 while making copious urine, pneumonia that won't heal, and he can't hold his sats above 85% without a venti and nasal cannula.

And a recent stroke victim who had an AVR and came down with a serious case of pump-head. He's so unpleasantly confused he's pulled nearly every tube and line possible, while restrained. He's been on the unit for almost 3 weeks now.

And for the 3 weeks I've been off orientation? Exactly the same kind of patients, night after night.

Grind your soul into the asphalt slightly-too-sick-for-the-floor confused med-surg patients. EXACTLY the kind of patients I busted my ass to get hired into a high acuity unit to AVOID.

I get that I'm new. I do. I really, really do.

But come ON.

Ok, Ok, I Want To Be Popular...

2011-04-29T22:25:00.009-05:00

...so please vote for me.

I got sucked in. Fibers.com is hosting a T-shirt design contest for Nurses Week. There are prizes, and of course in exchange, you fork over your intellectual property allowing them to market your T-shirt idea and profit from your creativity. But, it's kind of fun designing them and I highly doubt I'd get rich from the T-shirt business anyway.

Anyway, here's my designs, please go vote for me:

Vote for Nursing Poop Poseurs Here.

Vote for Nurses Saving Butts Here.

And one for the guys here:

Vote for RN-BSN-XY Here.

While you're there, design your own. It really is kind of fun.

Brought To You By The Letter, "Oh $#1T!"

2011-04-29T09:24:00.000-05:00

I learned something new last night.

You know what sounds like rain gently thrumming on the soft top of a Jeep?

Well, it turns out that blood spurting and spattering onto acoustic ceiling tiles makes almost exactly the same sound. Eerie really.

And that folks, is what happens when a patient pulls his IABP out of his femoral artery.

I learned something else last night too.

You know what sounds like a dropping a watermelon on concrete?

Well, it turns out that a fainting coworker's head smacking the floor sounds remarkably similar.

And that folks, is what happens when your pod partner faints when she sees blood spurting from her patients femoral artery after he pulls out his IABP.

Lucky for me I was already gloved up about to draw labs on one of my patients when I heard the aforementioned, very liquid sound followed closely by the monitor and IABP machine alarming. The other aforementioned sound rounded out the trio.

On a dead sprint to the other side of the room I managed to scatter the bucket of bed bath supplies for the sake of grabbing a towel, all the while yelling my head off for help.

The patient, all 6'5", 148kg of straight-up-pissed-off was thrashing around in the bed. He was intubated, and supposedly sedated on 60 mcg/kg/min of propofol (which is a 100 ml bottle every 90 minutes!). He apparently took exception to, well, hemostasis I guess.

I clamped the towel down on his fem site, then got control of his right wrist and pinned it to the bed. Next I stuck the elbow of my arm holding pressure deep into his quad and got him to straighten his leg. Lucky for me his other arm got tangled up in his vent circuit and I was able to should block his other knee or there's a good possibility I'd be wearing a black eye today, or worse.

By this time help was arriving, the crash cart got yanked open, the patient is in v-tach (as best we could tell), and was being restrained forcibly by 3 other people. The CRNA on call rolls in (their sleeping rooms are right outside our unit). He takes one look, calls for a vial of vecuronium and paralyzes the patient on the spot. The secretary is running for blood and a rapid infuser from the trauma ICU, there's a saline bolus running in wide open. Somebody shoots an index, it's like 0.9, but the dude somehow still has a pulse. His pressure is in the toilet, and although he converts out of v-tach with some epi, he still has ectopy all over the place. Someone was nice enough to set up a c-clamp because my arms are burning from holding that much pressure on the site (I may or may not have been trying to single handedly push his hip through the bed.)

Meanwhile a code purple has been called for my coworker and she gets C-collared and whisked off to CT on the way to the ED.

There was eleventy-billion people in the room, including family from the other 3 patients in the pod. They couldn't get out because there were so many people attending to the patient and my coworker. It was more chaotic than any code I've been to yet.

Surgeon arrives on unit, and he's pissed. He wants somebody's head on a platter, and since my co-worker cracked hers on the floor, I'm next in line. He literally wants someone fired. My night charge nurse steps up to the plate, and sets the surgeon straight--for which I'm truly, truly grateful.

"That nurse and his quick thinking is the very reason your patient is still alive!"

We did, in fact, get the patient stabilized. He's only slightly more sick than he was before the incident, and that is a very lucky thing. It could have easily been much worse.

I'm sure there will be all kinds of legal shenanigans and ass-covering in the days to come, but it was enough for one night.

In fact, I hope I never see that again!

The Honeymoon is Over

2011-04-22T15:36:00.003-05:00

It was nice while it lasted, but the honeymoon is over. The true colors of my coworkers are starting to show through.

Now that I'm no longer new enough for everyone to still be playing nice, all the personalities are starting to emerge. And on a unit like mine, you better believe there's some strong personalities.

To the nurse that found it necessary to inform the night supervisor I didn't get the SCDs on a patient until nearly shift change a few shifts ago, two things:

A.) I was at my other patient's bedside the vast majority of the night taking care of small things like, oh, keeping them alive.

B.) If you had time to keep track of when exactly I got the SCDs on the patient, couldn't you have helped me out and put them on yourself? You know, teamwork? Just sayin.

To my pod partner from last night:

I get that you're the top poodle on the nightshift now having reached the ripe old age of 3 years experience. I am also aware that our collective 4 patients were relatively stable, especially for our unit. However, you spending the entire night out of the pod at the nurses station yammering with your friends and cohorts meant that I was stuck in our pod all night caring for your patients and mine both. Not really that big of a deal, except that if I wanted to wear the soles of my shoes out running from bed to bed, I'd have gotten a med-surg job. And then having to help you get your patients primped and fluffed at 0600 in a frantic rush, while mine have been settled for hours? It should have been my turn to sit down.

To the dayshift nurse who told the night supervisor I didn't bathe my patient because I missed changing 1 of 6 dressings:

You suck. And you lie.

To the RT who didn't believe me when I told her a patient's ETT needed retaping:

I wasn't just playing about, and our patient really, really didn't need the exposure--or the jostling--of a stat portable chest X-ray to reconfirm ETT placement.

Oh, and to the unit in general:

I'm so very tired of hearing, "You have to be careful how you approach so and so about that."

Why can't I openly and clearly communicate my patient's needs to those responsible for assisting me in caring for them? I am so tired of having to slink up to various people from docs to support staff like a helpless, hapless junior high damsel in distress to get what my patient needs. Too many egos to stroke. I ~~demand~~ respectfully request you grow the #@$) up.

And it's only been 3 1/2 months!!!

ICU Psycho

2011-04-15T19:20:00.002-05:00

When I came in for my much heralded first solo shift it turned out I was assigned two patients that'd had floor orders since that morning, but no rooms available upstairs. So much for saving the world all on my own.

Pt #1 is a post-op day 1 CABG patient who, aside from being overtly particular, seems pretty chill. He's sitting up in the bedside chair, reading a book and just hanging out. I introduce myself, get report, grab vitals, and head off to meet patient #2.

Pt #2 is a post-op perf'd bowel resection. Brand new colostomy and ileostomy. The only reason he's on our unit at all is he's an old double lung transplant from 2007. He's the picture perfect double lung--10/10 anxiety, twitchy, constant guppy breathing--basically crawling the walls. He has a Dilaudid PCA and knows exactly when he got his last nurse bolus, and when the next one is due. And the last and next Ativan.

From the above brief description, can you pick which patient is going to be the troublemaker?

If you picked like I did, you'd be wrong.

I get Pt #1 assessed and charted, just in time for Pt. #2 to have an anxiety attack, (right on the scheduled Ativan dose time coincidentally), and head to his bedside. I get him settled down, drugs admin'd, assessed and charted. He slowly starts dragging his sats--was at 95% most of the day now consistently at 93-94% on 5L NC. (Cue ominous music.)

By 2100, I've assessed and charted both patients, given 2100 meds, hung about 4 different antibiotic IVPB's on Lung Boy (Hmmm immuno-suppressed and septic much?), and I've gotten Pt #1 into bed (in his Dean & Deluca bathrobe, no less). Lights out; Pt #1 drifts off to sleep and Pt #2...doesn't.

About 2230 Pt #1 awakes suddenly and starts yelling my name, completely freaked out. I dash to his bedside, only to discover...the bedside computer monitor has him freaked out. It's not on, it's just sitting there.

Pt #1 doesn't like this.

Now you're starting to see how this is going to go...

At this point he sits up on the side of the bed and tries to leave the unit. (Post op day 1, mind you.) Through some fancy wordwork I talk him down and avoid having to physically intervene. After 90 minutes of constant reorientation and reassurance, I manage to get him settled back in the chair and reading his book. Where he stays. The. Entire. Night. Hypervigilant. Refuses to sleep. Won't take his antibiotic because he's convinced it's spiked with something to put him to sleep (hmmm...not a bad idea thinking back...).

As the night rolls on, Pt #2 is getting weaker and weaker, it's clear that his physiological reserve is just spent. But he's hanging in.

Meanwhile about 0430 Pt #1 starts nodding off in the chair. He starts complaining how uncomfortable he is so I suggest getting back into bed and surprisingly he agrees. For the briefest of moments he appears to be going to sleep. But alas, the light comes back on and he continues reading.

By 0600, Pt #2 drops his sats to 88-89% and I start him on a non-rebreather, which perks him up to 98% or so. I figure I better notify the pulmonologist since that's a pretty big status change, not to mention it's after 0600 anyway--pager fair game.

It's while I'm on the phone with the pulmonologist getting a lecture about not trying a simple mask first before the non-rebreather (WTF?) that Pt #1's monitor starts alarming. After ~~hanging up on~~ politely excusing myself from the doc on the phone, I dash to Pt #1's bedside to discover he's in V-tach or SVT, and all hell breaks loose. My pod partner runs for some lidocaine, my charge nurse starts paging the on call CT surgeon, and I try and get Pt #1 to valsalva just to see if he's possible in SVT that we can convert.

And he flips out.

Gone.

Bonkers.

Looney.

ICU Psycho.

He's screaming obscenities, misogynistic slurs, anything he can think of. I'm physically holding him in bed after he assaults the RT trying to get an ABG. He tries to attack me, but he's 72, just had major surgery, and I'm probably 6" taller and 100 lbs heavier. He ends up in 4 point restraints struggling with all his might, which although puts him at danger of dehiscing his sternal incision, it's actually bringing his heart rate down because he's in one constant valsalva. Amio bolus on board, Haldol x10 mg, and that's where he was when I left after giving report.

Oh, and Pt #2? During report I coax him into coughing, and he coughs up a nasty black mucus plug and immediately starts satting better. (Guess who's a closet smoker with a double lung transplant.)

When I called in after I got up to check on the two of them, Pt #1 was in 4 point restraints, a posey vest, and mittens after scratching a nurse. Pt #2 had transferred upstairs.

It makes me wonder if Pt #1 would have been alright if he'd made it upstairs to a private room. Kind of sad really.

From the Beginning: Interview

2011-04-14T15:41:00.001-05:00

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about my nursing school interview, originally posted September 25, 2008:

My interview went well today. I only managed to tongue tie myself once. My interviewer's office phone went off 3 or 4 times, her personal cell phone went off once, and someone knocked at the door and intruded. Interesting.

The questions were pretty basic:

Why do you want to be a nurse?
What are some qualities of a good nurse?
What are your strengths that you would bring to nursing school?
What are your weaknesses that you would bring to nursing school?
How do you study?
How do you plan to deal with the rigors of the program?
Do you plan to work?
Think of a time when you had a great deal of stress. How did you deal with that stress?

The one that made me think was:

Think of a time that a problem couldn't be solved with your current way of thinking. What did you do to solve the problem?

All in all it was a relatively painless experience. She seemed genuinely attentive, and took notes on my answers. When we were through she all but told me I'd gotten in. Acceptance letters go out towards the end of October, so I'll be glad when it's in my grimy little hand. Orientation is Jan 7 and 8, but classes don't start until after the 20th. Nice little break there to get myself properly immunized.

Oh boy.

Solo, and not the big red plastic cups.

2011-04-13T12:05:00.004-05:00

Tonight is my first solo shift.

NurseXY RN-BSN.

No more "Let me ask your nurse...", "Let me ask my preceptor...", "What do I do now..."

Just me and my paper brain. I'm probably making a bigger deal out of this than it really is. My coworkers are really great about helping, and I haven't met any of them that I feel I couldn't ask to help me. I have been essentially on my own for a few weeks now, even with a preceptor. Multiple times my preceptor got called away to take patients of their own, so it's not like it's my first time solo.

Still, it's different.

There is an excellent chance I will get floated tonight, or even left at home on call because coming off orientation puts me right at the top of the "bad list". Both of my fellow ex-interns floated their first night off orientation. They both said that it was simply boring being off our unit. At least I don't have to worry about a step up in acuity, haha. And the nice thing is we can only be floated to other ICUs, no floors.

My first shaky day of clinical (during which I participated in a code, got to put in a flexiseal, put in a foley, and started an IV--we were only supposed to observe, haha!) seems like a long time ago, mostly because it was way back in 2009. Not to mention the hurdles I've crawled over, ducked under, or simply lowered my head and obliterated since then.

I'd wax nostalgic, but I really need to get some lunch and then take a nap before my night shift.

Thanks for reading about my journey and offering bits of advice and encouragement along the way. It means a great deal to me.

Special shout out to Kirsten, Tiffany, and Running Wildly for being with me from the bitter beginning--probably couldn't have made it without you!

From the Beginning: Busy Day Tomorrow

2011-04-10T18:37:00.000-05:00

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about prerequisite classes, originally posted September 24, 2008:

I have a busy day tomorrow... Start things off with an Anatomy & Physiology exam at 9:30, but I'll be up at school long before then, studying. I think having a Bachelor's in Human Anatomy is actually spurring me to study harder. I'm deathly afraid that I'm going to slack off, thinking I can coast on my prior knowledge, and I'm going to get smacked. How embarrassing would that be? Failing an undergraduate anatomy exam would just top off my whole chiropractic school experience. I should be fine, there isn't much material covered, and I am comfortable with the material. Still though, when one gets complacent...

Then I have class until 1400. At that point I head home in time for my girls to get home from school.

Then out the door again at 1630, all spiffed up--suit and tie. My nursing school interview is at 1730. It's an exciting step in my journey, and I hope I'll sleep tonight. I am scheduled to interview with the Assistant Dean, the one in charge of admissions--no pressure, haha! The interview is scheduled for 30 minutes, and my classmates that have already interviewed said to expect to be there for every minute of it. As long as I don't fark up my interview, my advisor has all but said I'm a shoo in. I hope that holds true, and I really hope I don't fark up my interview! We'll find out officially by the end of October. Hopefully the mail moves a little more quickly than it did with my interview letter--it took a full week to travel less than 10 miles, within the same city.

I've been thinking about what I'd like to do once I'm through with nursing school. I'm almost certain that I could be just fine working as an RN in a critical care unit somewhere, hopefully a pediatric critical care unit. I've considered the thought of working on a transport team. How fun would that be? Travel, and nursing. Not to mention all the autonomy being in transit affords.

I have also thought about continuing on a bit. I could see myself as a Nurse Practitioner working on a critical care unit. The salary increase isn't very substantial over working as an RN though. Another thought is becoming a CRNA. Big time salary potential there and that's not something to blow off...

I'm sure the path I'm supposed to take will be revealed at some point. Let's hope sooner than later!

From the Beginning: Chest Pains

2011-04-08T18:34:00.000-05:00

Since my posts here have become a little sparse, I thought this might be a good time to consolidate my nursing school posts from an older blog. Here's a post about interview letters, originally posted September 13, 2008:

This is the start of a new blog, and I'll update with back story as we get further along. But for now, I'd just like to get a post on the books.

Wednesday in my nursing concepts course, the Dean of the nursing school dropped by. She was there to relay information that the nursing school has changed their application process, and instead of submitting a writing sample, the HESI A2 exam would be used to assess verbal and written communication skills. This wasn't news to me as I'd already taken the HESI as a part of my application process for Spring 2009. The exam did not prove strenuous and thankfully I scored very well. Apparently however, there were 4 applicants for the Spring 2009 class that did not take the exam during the appointed times, and thus their application was incomplete. Since ours is the first applying class to use the HESI, the nursing school has made arrangements to allow those 4 students to take the exam anyway, though the deadlines are past. I'm not sure I agree with that--the nursing school did send two letters and numerous emails about the HESI, but I suppose compassion is the best policy. Especially if I were one of the 4.

Anyway, during her 5 minute spiel, the Dean mentioned that interview letters for the Spring 2009 applying class had been mailed two days earlier, on Monday. Sitting in my seat, I got goosebumps. I knew that this could very well mean that if I were selected for an interview, my letter was probably sitting in our mailbox at that very moment. I had to strongly resist the urge to gather my things and slip out.

Alas, when I arrived home, there was no letter in my mailbox.

Now, for perspective, I live about 10 miles from school, in the same town. Mail usually travels within the city in one day. Mailed on Monday would have a strong possibility of being delivered on Tuesday, and almost positively by Wednesday. Stretching to Thursday was unusual, but not beyond the scope of imagination.

Thursday afternoon the mail arrived. No letter.

At this point I was getting concerned. My conversations with my advisor, and even the Dean, had led me to believe that I had a very strong chance of being accepted to the program, but I was beginning to have doubts.

On Friday, I made a special stop at the house to check the mail between a business lunch and my anatomy lab.

No letter.

Now I was relatively certain that a letter was not mailed to me on Monday, and the panic began to set in. My hands were shaking, my mind was reeling, and I honestly had chest pains. I'm not sure if that's how anxiety attacks feel, but I do know that I was not in a happy place as visions of our carefully laid plans came crashing down around me.

I knew that if I let things ride, I would be a wreck all weekend long. I needed action. I needed answers. As I drove my way to campus, I dialed 411 for the number to the nursing school and called to make an appointment with my advisor. Luckily she had an availability, even late on a Friday afternoon. Meanwhile, I numbly sat through anatomy lab, making small talk to my lab partners, and making all the incisions in our fetal pig for our group. (It's amazing what two trimesters spent dissecting a human cadaver for gross anatomy will give you tolerance for...or callousness to?)

As my advisor walked me back to her office, she asked how she could help. I tried very hard to remain completely calm and affable, and I think I did a pretty good job. I told her I was curious about my application, as I knew that the interview letters had been sent out, and I hadn't yet received one. In fact I was wondering how I might strengthen my application so that next semester I might be selected to move on in the application process.

She frowned at me and said, "But we mailed your letter just yesterday."

It turns out that since I have a professional degree already, I'm in a different applicant group than normal undergraduate applicants. My group's letters hadn't gone out until Thursday.

I'm certain my spontaneous relief was transparently obvious to her, because she apologized for having stressed me out so badly. She then made a copy of the letter from the duplicate in my file so I could bring it home with me.

All's well that ends well, right?

Well, one would hope, but now the system won't accept my login name to schedule my interview...

To Hell & Back

2011-04-06T20:39:00.005-05:00

Tonight I accompanied my wife to a yoga class at our gym.

You have no idea how huge this is.

I suck at yoga. When we first got our Wii Fit, the yoga game frustrated me beyond belief. I had very little balance. It had a great deal to do with my being overweight--it's hard to control your body when you're carrying around the equivalent of an extra human being on your back.

Tonight the class was supposed to be hot yoga, but apparently the heat in the room was broken so it was more like luke-warm yoga. Regardless, I was pleasantly surprised at how many of the poses that used to elude me I was able to accomplish in some shape or fashion. I was even able to do the higher level variations a few times. Overall it was a really positive experience.

But this post isn't about yoga.

During the quiet reflection time at the end of the class, I was almost overwhelmed by a rush of emotion. I was nearly brought to tears as I became acutely aware of the grinding, oppressive intensity of my job.

Critical care nursing is a violent, violent beast.

The inhumanity of so many of the "interventions" we implement is staggering. We often do things to our patients where the success or failure of the therapy depends solely on our determination to see the procedure through to the end. Our patients are broken, hacked into pieces and put back together, sometimes not in the right order or composition. We administer vehemently severe drugs that force the body to battle against itself to raise a blood pressure, or increase perfusion, or to be stone still when the entire body aches to thrash about in protest.

This realization caught me by surprise. Actually, the discordant nature of what I do to heal people caught me by surprise.

My compassion for my patients abounds--this isn't the issue. I feel for them; I practice from an empathetic heart.

But this is different.

This is about me. And the horrors I witness on a daily basis in the due course of my job. My career. My livelihood.

Like I'm a computer programmer, or a grocer, or an account customer service representative.

Except that I'm not.

When people ask me what it is that I do, they have no idea the profundity of question they are asking. And I reply like I change oil for a living. Or buy bonds on the stock market.

The reality is my unit is a battlefield. A desolate, bleak, derelict, forsaken, smoking wasteland. Where Death prowls like the inky darkness at the edge of your vision. Where I'll make deals with the Devil to save a soul so they can gasp a few more breaths. Or if we're all lucky, and have muttered the right incantation in the right timbre, to the right lord of medication, the patient pulls back from the brink and returns from the land of nowhere. Where I will attack, wage war, and blatantly injure a patient in the name of healing them.

And so I go, petting the hellhounds, whispering in their ears so that I might escape with one more patient's soul.

No rest for the weary.

But there must be balance.

Namaste.

As the Internship Wanes

2011-03-30T14:18:00.000-05:00

It was a lifetime of 12 short weeks ago that I embarked on this critical care internship. I thought I knew what it would be like, and I was mostly right.

The fact that even in the interview they asked me if I was sure I "wanted to do this", again when they offered the position to me, and a third time when we were at the beginning illustrates the degree of difficulty. The neck snapping uptake onto this learning curve was akin to being rear-ended by an academic semi-truck on a towering bridge--not only do you have to survive the impact, you have to make sure you get propelled down the lane of traffic and not over the side of the bridge into the water. I've always prided myself in some small way on the amount of stuff in my brain; it's what I do, it's my thing. This, however, was the first time where my knowledge, or potential lack thereof, had actual life or death consequences. And I don't mean that in a hyberbolic, grandiose way. I mean that quite, quite literally. Often, if I were to screw up, there simply isn't time or physiologic reserve for the patient to recover.

This is singularly the most difficult thing I've ever done. So far beyond nursing school it's laughable. Easily more intense than the worst day in chiropractic school. The level of performance required on a minute to minute basis leaves me mentally and physically exhausted at the end of each and every shift.

I have assimilated so much knowledge my head hurts and I dream about titrations, QTc's, filling pressures, and cardiac indexes. Yet I'm surrounded by people that possess the same knowledge, at times seemingly disguising the fact that I've learned all that much.

I can tell that I've grown though. It used to be when a preceptor stepped in and made an adjustment to a pump or initiated a therapy, I was simply thankful that there was someone there to make sure the patient got what they needed. Now, it annoys me, because a.) they don't tell me what they've done, potentially making me look like a fool when I get questioned by a physician, b.) because it disrupts my train of thought or plan of care, or c.) because, "It's my patient damnit, and keep your grubby hands to yourself!!", that's why!

To get out of the internship I have to take a drug test tomorrow, and not the pee-in-a-cup kind either. These are the notecards for the drugs I have to know by heart. The test? Not multiple choice, not fill-in-the-blank, but short answer. Many of them I know well because I've used them daily for the past 12 weeks. Some of them I still haven't seen in practice. I have to know class, mechanism of action, preparations--including all concentrations we use, dosing--including initial, titration, max and wean dosing, side effects, nursing actions, as well as surgeon preferences for each drug. But no problem, I got this. *sigh*

Beyond that, I have two more shifts on days, tomorrow and Friday. Then Monday, I head to night shift for 3 shifts with a preceptor to get a feel for how things run on nights.

And then, fin. All done. Completed.

On my own.

And the next new adventures begin...

I love my job.

The C-Word

2011-03-27T20:42:00.000-05:00

Collaborative.

It's one of those magic buzzwords that we in health care like to liberally sprinkle around in our conversations when we're feeling particularly self-righteous and saintly.

Please don't mistake my flippant comment as total disregard for the concept. I do, in fact, believe it is absolutely the best possible framework for patient care. I just wish people used it for more than a feel-good talking point.

I think nursing as a whole accomplishes collaborative care the most consistently, at least at my hospital. We actually coordinate much of the inter-disciplinary care; we often facilitate the communications between disciplines. We're like home base--everyone checks in with us. The way we choose to phrase patient condition or answer questions can significantly alter the course of patient care.

It's a power not all nurses realize we wield. Maybe it's most seen in the ICU setting where patient condition can drastically change by the time a doc walks from one end of the unit to the other. They truly depend on our eyes and ears. Still, even we nurses don't always play nice either. How many times have you heard nurses complain when case management steals the chart? Or grumble when X-ray shows up just as we got the patient settled (regardless of the fact that we called them)?

The docs though, they can be real stinkers. (Not all docs, but enough to stereotype.) I often wonder if they think we don't have ears, or that we only hang out at the patient bedside when they're there. Do they not realize that we get the whole picture? From shift beginning to end, we entertain every discipline, and that we actually see what really takes place regarding the things they complain about?

I've heard several docs make snide remarks when pharmacy leaves notes to them in the chart. Often it's regarding vancomycin dosing, or GI prophylaxis--not entirely unimportant issues. In fact, I had a doc tell me to tell the pharmacy to "shove it up their ass" when they had me contact him about ordering Bactrim and Zinacef on a patient with documented sulfa and penicillin allergies. I hadn't caught it yet, but I hadn't given a dose of either yet. The patient did however receive doses of each in the OR--I guess that's what that red truncal rash was, aye doc? Funny how it disappeared after a dose of Benadryl.

Or how about the docs that brush aside the palliative care team? Or disparage the lab for taking so long with their stat super-specific free level neutrogenic assay panel level?

But docs aren't just hard on other disciplines, they have it out for each other too. For example, take the double lung transplant we had last week. The surgeon, Dr. Particular, put the patient on an epi drip to keep cardiac output up, and blood shunted centrally. Not a lot of epi, 0.03 mcg/kg/min, but it was enough to keep the patient in sinus tach and SBP in the 150s. The pulmonologist, Dr. Low-Key, came in and and D/C'd the epi because he didn't like the pressures that high on the new anastamosis and the lung capillary beds.

Having worked with the Dr. Particular before, I was pretty certain he wasn't going to take someone monkeying around with his drips too well. So I discontinued the epi while Dr. Low-Key was there, and as soon as he left, I paged Dr. Particular.

"What!?! That is MY drip. All the vasoactive meds are MY meds! Why would Dr. Low-Key D/C drips that are mine! We don't just D/C drips like that!" Etc, etc, ad nauseum.

So the epi went back on (actually, as far as Dr. Particular knows it was never turned off). And when Dr. Low-Key came back through for afternoon rounds, I had to play the other side of the fence. "You know how Dr. Particular is, he likes his drips." And we had a round of teasing and snide remarks at the expense of Dr. Particular. In the end, Dr. Low-Key left placated. But the drip was still running.

When Dr. Particular came through to write his progress notes, I was able to bring up Dr. Low-Key's concerns carefully disguised as nursing recommendations, and got the epi weaned to 0.015 mcg/kg/min, which kept her CO/CI at 4.8/2.7, but allowed her pressures to settle into the 130s. All the while bantering about Dr. Low-Key's "slip-shod practices", just turning off a drip without weaning, and generally talking up the other side of the fence again. Gleefully, Dr. Particular left vindicated.

And the patient maintained perfusion, with tolerable systolic blood pressures.

Yeesh, I think foreign relations in the Middle East aren't this complicated.

But that's collaborative care.

The C-word.

Dr. Slapstick

2011-03-20T19:02:00.001-05:00

I mentioned one of the CT surgeons at my hospital in past posts. I thought I would elaborate.

Now, CT surgeons by breed tend to be a little "off" in my experience. Whether they suffer from grandiose delusions or are just odd little men, the sheer amount of schooling/residency/fellowship required to become a competent CT surgeon tends to emphasize a certain margin of the population.

Dr. Slapstick is no exception. He truly is a strange little man.

He creeps out some of the female nurses because of his over-friendly manner. Among the chosen few is my fellow friend intern, Ash. She's managed to attract his attention, and he's so slimy about it he makes both of our skin crawl when he's around her. It's not hard to decipher his intentions.

He's on his 3rd wife, and she truly is a trophy wife this time around by all intents and purposes. She is much younger than him, is legendary for her "good" looks, and apparently previously made her living at various fine gentlemen's establishments.

Not that there's anything wrong with that...

Did I mention he's the medical director for our unit?

But that's not the real issue, however scandalous it may be.

I call him Dr. Slapstick because of his technique. And I don't mean the way he woos the ladies. His surgical technique. CT surgery is a sport to him. Each case is a race to him--I've seen him finish a CABG in under an hour. While that does wonders for productivity, it leaves much to be desired in patient outcomes.

Dr. Slapstick's post op orders regularly include keeping the patient's MAP between 50 and 60 mmHg. He claims this is to protect the new grafts, but it is common knowledge that it's actually to prevent his slapstick grafts from bleeding. He is adamant about the pressure, and will often watch his previous case in the ICU on the monitor while he's working on his second or third case in the OR. If your pressure begins to even think about straying north of 60, we'll get a phone call from him, from the OR suite. For the uninitiated, a MAP of at least 65 mmHg is required to adequately perfume the kidneys, in a healthy patient.

Remember the patient that tamponaded and coded that I mentioned in my last post?

A Dr. Slapstick patient.

Ash (her patient) and I couldn't figure out why nobody would call a spade a spade and actually label it tamponade. It was textbook as it comes--agitation, brief spike in BP, then falling BP, narrowing pulse pressures in the art line, dampened art line wave form, PAD and CVP equalized. Not to mention when Ash manipulated the mediastinal chest tubes, they were clotted and then dumped 300 mls. But nobody was willing to chart that the patient had tamponaded, let alone was bleeding. After asking our educator what we were missing, she let us know that Dr. Slapstick was being looked into by the board. Apparently he has one of the highest return-to-OR rates in the country...

Not sure how I feel about my coworkers trying to cover for him...

Today

2011-03-16T22:51:00.002-05:00

5 am has come way too soon. On nights before I work a shift on the unit, I worry so much about oversleeping that I wake up nearly every hour through the night to make sure I haven't slept through my alarm. Usually my jaw muscles are aching and quivering by morning because I've been clenching my teeth--a sign of the tension I'm carrying about my upcoming shift.

As I pull out of the driveway, the brisk 50* March morning breeze tousles my hair. It's one of the things I love about owning a Jeep--the removable top. My morning NPR thrums in time to the tires rhythmically bumping over the expansion joints in the concrete roadway. I sip on the Dunkin Donuts french vanilla coffee that my wife brought home for me to try. Its toasty roasted warmth permeates my sinuses, coaxing my brain awake.

I get to the remote parking lot just in time to catch the early shuttle, saving me a 1 mile walk from lot to unit. I sit near a former classmate of mine from nursing school that got hired into the OR internship at my hospital, happy to see a familiar face. Early morning small talk splatters across the aisle, like dew dripping from hesitant grass.

Once on the unit, I'm 30 minutes early as usual, and check out the assignment board. I discover I've been assigned to a tough pair of patients--neither one entirely lucid, swimming instead in the murky waters of ICU psychosis. I notice my hard-ass preceptor is back from his 2 week paternity leave.

*Sigh*

It's going to be a long day.

I head into my pod and get report 20 minutes early, just to get a jump start on my day. As expected, both patients are super busy, and heavy on meds and tasks. They've both been on the unit a full week or more. That's about a week longer than most of our heart patients--we transfer out on post-op day 1 when things go right. One patient has had seizures and other neuro complications. The other has been in 4 point restraints for most of the week to prevent him from pulling out his balloon pump and flopping onto the floor to writhe around like an out of water guppy.

As I'm doing my morning assessment, my seizure lady kicks into full-on anxiety mode. Taking her hand in mine, I get her to focus on my face and gently talk her down from her ledge. She tearfully thanks me for helping her, and profusely apologizes for being troublesome. I assure her that everything will be ok, and it's my pleasure to help her. "We're going to get through this day together," I promise.

It's a scene that will repeat several times during day.

Meanwhile my 4 point restraint man is satting 100% on bipap, but shaking his head like an angry mule trying to dislodge the mask. I DC the bipap to a simple mask at 30%, just to see what he's going to do. Eventually I get him down to 3L NC, still satting 100%. He begs me to get him up to the chair, and I oblige--releasing 2 soft point restraints per limb. Once he's in the chair, he is completely lucid and cutting up, causing trouble.

The good kind of trouble.

As his family comes in to revel in his new found lucidity and good fortune, he gets very emotional. His fear that he'd never see his wife of 65 years again is a heart-rending confession when she comes in to visit with him. They're only 87 years old. Halfway through the shift he starts weeping, and as I try to console him he thanks me for saving his life. What words are adequate to respond?

I kick seizure lady's family out of the pod so she can sleep. I'm convinced her psychosis and seizures have more to do with sleep deprivation than a neuro issue. Towards the end of the shift I convince the CT surgeon to transfer my seizure lady to the floor where she'll have a private room, and blessed sleep. I lecture her family about talking her into asking for pain meds. Maybe if she's not on Dilaudid every 4 hours her GI tract will break free from its paralysis. They fuss at my iron-handedness. They thank me profusely as I transfer them to floor, regardless of me taking them to task. In the waiting room I overhear them bragging on me to the other families.

When I get back from transferring my patient, I assist with a new admit surgery--a fresh CABG. That's when the woman across their pod chooses to tamponade and code. I'm next in line to do compressions when we get her back. Her 16 year old grand daughter was bedside when it happened. I shepherd her into the waiting arms of the chaplain as I dash down the hall to pull another 750ml of 5% albumin from the Omnicell. It's a delicate ballet--a well orchestrated exercise in futility. Her RCA perf'ed in the cath lab, and her entire right ventricle and most of her septum has infarcted. She's not long for this world, but we did buy her another afternoon conversation with her grand daughter. Worth it I think.

4 point restraint man gets visibly upset when I let him know I won't be back the following day. He worries that his new nurse will let him down and that he'll sink back into the confusion. I settle him as best I can, and reiterate his goals to get to floor, and then home. I think he halfway believes me when I tell him that he's going to be fine.

Surprise. I admit a patient with Marfan's. She's been in the ED all day with hemoptysis and a deep tearing pain in her chest. Hmm, dissection anyone? I have just enough time to get her settled and an assessment documented before I have to total out my I&O's.

Night shift has moseyed in. I'm lucky--the nurse taking over my patients is as punctual as they come. I give report, astounded that the 12 hours I've experienced can actually be condensed down into a 10 minute synopsis. We check orders, and I autograph the chart with a flourish.

My crusty preceptor tells me, "You did a good job today," as we clock out. I'm dumbfounded.

My nursing school classmate that works on my unit was the primary nurse on the patient that coded earlier, and I let her decompress on me as we walk the mile back to the remote lot. Her husband is supportive, but doesn't understand all the pressures we go through. He doesn't understand the subtlety and gravity of the events of our day. She destresses and I just listen as we walk. By the time we reach the parking lot, she's calm enough to drive. I know she'll do the same for me, and likely soon.

As I climb into the Jeep for the drive home, I realize I've parked under a flowering pear tree. There's a layer of fragrant petals sprinkled across the interior. As I pull onto the highway, the freeway evening breeze turns them into a petal snowstorm. They swirl around me and lightly flutter across my face, reminding me of the gentle way we as nurses can affect the recovery of our patients. It goes way beyond the obvious, lifting gently into the air in a menagerie of healing.

And for what must be the hundredth time in a week, a month, a year, I thank my lucky stars that someone, somewhere saw it fit to place me in this time; this moment; this space.

On Mountains, Valleys, & Beasts

2011-03-10T12:15:00.000-06:00

One of the foremost lessons I've learned in my internship is that our unit is like a live, wild animal.

It breathes. It eats. It's reactive.

And if you're not careful, it will bite you.

Just when I think I've gotten a handle on it, something comes along and takes my legs back out from under me, leaving me on my knees.

And so it goes--I have huge mountaintop experiences where I've safely admitted extremely unstable and complicated patients. It is such a rush when you're literally managing a hemodynamically unstable patient's life on a minute by minute basis through the titration of 4 or 5 different vasoactive drips. It's cathartic. And it's easy to see how god-complexes develop in physicians because it's addicting. It feels oh-so-good when you're doing it the right way and your patient lives. The rush whispers in your ears, seducing you with it's siren words of success. I've had 3 such admits so far, and I only look forward to more.

But there are the valleys too. Like when a simple case comes back, and suddenly I'm paralyzed because nothing is as it should be. There's no index to shoot, there's no cordis, but I've got two art-lines, and I don't know why. The patient is a 31 year old mother of 3 that discovered she had a ASD when she had a TIA at home taking care of her kids. A simple septal defect repair done through the femoral artery--it completely blew my mind and I imploded. I simply couldn't think of what I needed to do next. So humiliating, and unbelievably frustrating.

I just have to keep getting up and going back to work. It may not get any easier, but I know I'll be better for it in the end. And I can tell I'm becoming a stronger nurse each passing shift.

And that my friends, is even more cathartic, and more addicting.

The thirst for knowledge and experience is almost unbearable at times. My skin prickles from the sheer volume of electrical activity required to lay down the new neuronal pathways. It's like a drug. And it's not always a therapeutic dose. Often it's a back-alley, Bic-lighter-and-rusty-metal-spoon black-tar of a rush.

The knowledge also lives and is animate, I swear. I can feel its hot breath on my neck while I work and move among my patients. It lays in wait for the right moment to pounce on its unsuspecting prey, to remind me that I am not in control of it. Untameable. But when harnessed, lurches us forward at synergistic ability and speed...

And so I exist, abiding in the mist of the gray, no black or white in sight. Between scope of practice and patient need. Trying to bridle the knowledge just enough to battle the specter of the horrible beast that is the life-or-death illness that stalks the patients on my unit. All the while I'm holding on for dear life, only hoping to come out the other end of the shift having honored the needs of the patient and served their families in a way that I can be proud of.

And I love it.

Every.

Vicious.

Second.

ACLS Drama

2011-03-08T17:08:00.000-06:00

Because of our patient population, unit policy states that to travel with a patient (to radiology, dialysis, or even transferring to the step down unit), the nurse accompanying the patient must be ACLS certified.

Hospital policy states that new-hires must become ACLS certified within 12 months of hire.

Obviously, waiting 12 months to take ACLS isn't really an option on our unit, since a good deal of our patients travel, and not being able to accompany them becomes a logistical staffing nightmare. And that's not even considering the sheer number of codes we see... Therefore, our educator and manager both "strongly encouraged" us to take ACLS before the end of our internship so that we'd be certified when we come off orientation.

My fellow interns and I sit on the front row during the classroom portion of the internship. The classes are combined with all med-surg, tele, and ICU interns, and that's what our unit does--"we're the best of the best, and we act that way." Or so we were "strongly encouraged" to portray by our manager and educator. One day as the internship class broke for lunch, my fellow interns and I discussed heading over to the unit to pick up the books for our Saturday ACLS class so we could take the pretest.

And thus started the ACLS Drama.

The class instructor overheard us, (a conversation she was not part of,) and flipped out.

"You haven't had the entire EKG interpretation internship course yet. We haven't talked about any of the ventricular arrhythmias. We haven't introduced the blocks yet. You won't even understand what they're talking about in the ACLS course, so it's pointless for you to even go right now!"

As insulting as this was ("You're too stupid to take the course!"), I have turned over a new leaf, and I let it roll off my back, shrugged my shoulders, and said, "We're just doing what our manager and educator told us to do."

So the class instructor called our manager to gripe. And she called our educator to gripe. And then she called the ACLS instructor and told her that we'd signed up and couldn't possibly be ready for such an advanced course.

All around us the political (and hormonal I suspect) firestorm raged, but our manager directed us to take the course regardless.

Meanwhile, I had an entire semester of critical care in nursing school that incorporated EKG interpretation throughout. I also had a year's ICU experience where rhythm identification was a daily part of my job. I know what a heart block looks like first degree, third degree, even both types of second degree. I know enough to say, "Oh S#&%!" when the monitor screen fills up with v-fib squigglys or v-tach scribbles. Hell, I even know that a nice pretty rhythm is useless without an accompanying pulse.

But I digress.

When I showed up on Saturday morning for ACLS (with pretest with passing score in hand), we quickly sailed through the BLS portion of the course and then split into renewals and first time certifications. There were only 5 of us first timers--the 3 of us from our unit, and then a nurse with 4 months experience and a nurse with >20 years of experience that had let her certification lapse. As soon as we were separated out, the instructor starts in on a tirade of how those of us in the internship, "with so little experience," weren't going to reap the full benefit of the class, etc, etc, ad nauseam.

I'd had enough.

And so I went all nurseXY on her.

"I guess I'm confused. Do we need to sign up for another class? Are we not allowed to take this class?"

"Well, no, I can't keep you from taking the class."

"Then why are we still discussing this? And when will we move on to the course content?"

Not particularly diplomatic, I know. Rude? Quite possibly.

But SHEESH!!

And so we began. As we moved into the content it was immediately clear she was singling us out with questions, trying to trip us up and make us feel inadequate or unprepared. What she didn't realize was how hard we had been pushed to learn drugs used daily on our unit, most of which are code drugs. She didn't realize the amount of physiologic and pathological knowledge required to get through a single shift on our unit. She didn't realize that we had to truly understand our patients disease processes to even begin managing them.

Everything she threw at us, we had a ready answer for. It was downright inspiring--you could hear the triumphantly rowdy underdog music swelling in the background. And then we caught her in a mistake.

In the end, after all the fuss, in our "but this is the way we do things" face-off, she was the one who blinked first.

As the day moved on into the megacode and we took turns at each position, it was quickly apparent that the other two nurses were actually the weak links.

For example, the one with 4 months of tele experience couldn't wrap her head around the concept of PEA--interestingly enough exactly how much experience our class instructor told us we needed to have to fully understand the intricate subtleties of ACLS. The other, the one with >20 years of experience kept mixing up atropine and amiodarone, and forgetting to defib the patient when appropriate.

One of my fellow interns summed up the day perfectly: "And it was us she was worried about?!?"

Today in class, more than 3 weeks later, we finally went over the heart blocks and ventricular arrhythmias. And wouldn't you know it the whole inappropriately early ACLS class came up again! And then we were politely asked to stop answering questions during the lecture and let others have a chance as we learned about hospital SDMOs on cardiac resuscitation, which oddly enough mirror ACLS.

Ugh. I hate drama.

Honor, Truth, Trust

2011-02-25T22:01:00.004-06:00

Truth be told, I probably shouldn't be writing this post right now as exhausted as I am.

But today was such an epic day, I feel like I can't let a night's sleep go by without documenting it lest the urgency and intensity of these newly learned lessons fade away like a groggily remembered dream upon waking.

Today I was stretched to my limit in regards to knowledge, ability, precognition, skills... Any and every aspect of being a nurse was tested today. These are the days that make the battle for a position on a badass unit in an amazing hospital totally worth it.

I started the day with one patient. A complicated, but stable patient. I then admitted the first heart case out of the OR. The surgeon doing the surgery is known for his speedy technique, often he's done with CABGs in less than 2 hours.

Today's case took 5.

The patient was a re-do, having had a CABG x4 15 years ago. Today he had a CABG x2 and an AVR. The patient came crashing into the unit a little before noon with a SBP in the 50s. The anesthesiologist dinked him to get me enough BP to get him hooked up and a cardiac index shot. We got him started on epi, dobutamine, and levo. He was still tubed and was on propofol and precedex to boot. His index was crazy. His output was 7.5L, his index was 3.5, but his stroke volume was 40.3 and his SVR was 457... Whacked out numbers.

Once I regained a human BP in the patient, I then set about lowering it. This particular surgeon likes his MAP to be 55-65. Yes I know that the kidneys aren't being perfused at that pressure, and lord knows he's been told that a hundred times, but he doesn't care about the kidneys. He just doesn't want his slapstick grafts to bleed.

But that's a post for another day...

So I started weaning the epi and the levo, and ramped up the propofol and started nitroglycerin to bring his pressure back down. I finally get the patient stable with a SBP in the 70s, but a MAP of 55 just as the surgeon would like.

And then the brown stuff hit the proverbial fan. His rate shot up to the 120s, he dumped 400 ml out of his mediastinals in 45 minutes, his CVP dropped like a rock, and he started having PVC's and small 8-10 beat runs of v-tach. I crammed in 1250 ml of albumin, 3 units PRBCs and 2 units of FFP, and his hematocrit came up two lousy points.

Mercifully, he pseudo-stabilized and I thought all was good again, until I treated a 4.0 K per physician ordered protocol, and suddenly he has a 30 beat run(?) of v-tach and his SBP falls to the 50s again. He earned himself 2 grams of mag, an amp of lidocaine, and a lidocaine drip. He also just about sent me into SVT myself. Sent off a K level out of curiosity, and a 40 meq treat bumped his K from 4.0 to 5.2, all the while his urine output was >100 ml an hour. Tell me how that math works out!

But that wasn't even the hard part of my day.

This man's family was amazing. Sweet, sweet people, and very, very worried. But the complete trust and faith they had in me was staggering. And the sense of responsibility that generated was unexpectedly profound. I've always had a strong sense of duty to the patient--I'm well-versed in advocating for those that aren't able to stand up for themselves. However, the burden of care I experienced today was new to me, and it caught me by surprise a bit.

It struck me that where there was once an empty bed, a quiet, unoccupied space, now it was filled with love, worry, and concern. It was such a transformative experience--it was palpable in the air. My biggest fear was that I was going to let this wonderful family down. I have never worked so hard to stabilize a patient to date in my nursing experience.

Meanwhile, I was also counseling and supporting the wife of my other patient as she made the difficult decision to direct her husband's care from the western curative model to one of palliative care and a dignified end of life. She too was super sweet and so, so vulnerable. Hundreds of miles away from home and completely alone, she needed a great deal of help. The palliative care team was coordinating withdrawal of care as I left for the night.

Any day that I can learn something is a day not wasted. Any day I can be stretched to my limits without breaking is a blessing.

Today was a good day.

On The Other Side Of The Stirrups

2011-02-16T16:54:00.000-06:00

I accompanied NurseXX to her first well-woman check-up since my son was born 2 years ago. Since the midwife group who presided over his birth only see OB patients, we were trying out a new OB/GYN.

As a healthcare professional, I tend to sit back and evaluate the experience perhaps with a little more objectivity than the average bear. Here's what I saw.

Our appointment was scheduled for 1330, and being new patients we were asked to arrive 15-20 minutes early to fill out paperwork. We arrived at 1310, and the doors were locked. When we were let inside the first interaction was, "Can I see your insurance card and drivers license?"

We were quite obviously the first appointment of the afternoon, given we were treated to listening to the lunchtime banter of a creepy, sleazy drug rep with the receptionists. Yet somehow we weren't shown back to the exam room until 15 minutes past our appointment time.

When we got to the exam room, the nurse took my wife's blood pressure manually, but did it so quickly there is no possible way she accurately heard any sounds. Oh, and inflated the cuff to 230 mmHG to start with. She then instructed my wife to change into a gown and drape after leaving a urine sample in the bathroom. Throughout the entire interaction, there was no greeting or "How are you doing?"

It was then that my wife realized the first time she'd meet the doctor, she'd be nude in a thin gown...

All in all the visit was actually a good one. The doc turned out to be super cool--she was very matter-of-fact, had an arm tattoo and a nose ring.

It just struck me that a few small changes could have made it a great visit, not just a good one.

Precepted. But.

2011-02-14T18:57:00.001-06:00

Everyone knows what makes or breaks an internship depends a great deal on how well an orientee and preceptor fit together. Some people need that warm fuzzy super supportive hand holder. Some people need the hard ass whip cracker to keep them on the straight and narrow. Some need constant supervision, while others are best left alone until questions arise.

Now admittedly, I'm a difficult case to match with the proper preceptor. I have a great deal of knowledge because of my background, and I've run across preceptor type people that get intimidated--they get hung up on that and fail to see my willingness to learn.

I want to know why we do things, so I tend to ask numerous questions. "Because the doctor wrote an order," and "We just always do it that way," are the bane of my existence. But I also want to learn how you do things, although I may quickly find my own way. I am a very kinesthetic learner, so to really own skills I need to actually do them, although I can reason my way through tasks intellectually. I'm capable of being quite flexible, but that can mean while I appear to be holding my own, I may not be getting what I need to learn or function best.

I'm not sure what the perfect preceptor for me would look like, but I'm pretty sure it's not the one that I've been assigned.

Unfortunately.

The hospital has set criteria for us to meet that count towards our yearly merit raises. The idea is that nurses who contribute back to the workplace take ownership of their workplace, and make it an all-around better place to work. These criteria include teaching projects, community service, leadership roles, and...precepting.

My preceptor has been banned from precepting females, apparently because he has a habit of making them cry. Although I suspect there was some chauvinistic behavior that didn't impress the ladies too much either, particularly since he's married. He's not much of a teacher, or a community service kind of guy. It pretty much leaves precepting for him to get his chance at the full 5% merit raise.

But.

That doesn't seem to take into account whether or not he really should be precepting.

He has all the tools. He's one of the most senior people on the unit, and at 8 years of service that gives you the idea of the turnover we experience. (We have 6 people leaving for CRNA school in August.) He is very knowledgeable. He is in a leadership position on the unit, working as a charge nurse.

But.

He has no people skills. He is sexist, and he constantly makes suggestive comments to and about the female staff members. He takes shortcuts--all the time. He laughs in the face of paperwork, often saying that if an issue can be resolved in the course of the shift, then the paperwork doesn't need to be filled out.

But.

Everyone puts up with it, and nothing gets done or said.

Fine, not my problem, right?

But.

Example #1: Second day on the floor, I'm given a new admit from the OR--a lung decortication secondary to aspergillus infection. Never taken care of a patient with that procedure done before, but she was vented and sedated with propofol, on a few pressors, on an insulin drip, and a fentanyl drip for analgesia--no big deal. My preceptor helped me get her settled, and then I went about managing her care--I was only supposed to have the one patient being my second day and all. About an hour later, he gets a patient from another floor--a trachea erosion secondary to radiation for esophageal cancer waiting for a tracheal stent. Pretty unstable patient actually. We get him settled in the bed next to my patient, and the two have our four bed pod to themselves. Things were clicking along just dandy.

But.

Then he disappeared, leaving me by myself with the two patients for the remaining half of shift.

When the oncoming shift comes in for report, come to find out the way my preceptor had told me to run the fentanyl drips (mcg/hr) is very much NOT acceptable on our unit--unbeknownst to me. It turns out we have a weight-based analgesia protocol in place (1-3/mcg/kg/hr for fentanyl). On the patient I was originally taking, what I was giving was actually less than the weight based formula minimum.

But.

On the tracheal stent dude I was running at 400 mcg/hr to keep him pain free. He weighed 110 kg, and simple math tells you that our weight based max dose of fentanyl is 330 mcg/hr...I was running 70 mcg/hr above our protocol max thanks to my preceptor's cowboy shenanigans.

If the patient had crashed, or become say, hypotensive, (like patients receiving fentanyl are prone to doing,) it would have been my ass hanging in the wind. My hospital has made it very, very clear that as long as we stay within the confines of the policies and procedures, they will back us 100%. Step outside the shadow of those protocols, and we've been told, in no uncertain terms, we're on our own.

I'm sure he'd have been in trouble too, his license in jeopardy, but frankly I don't give a shit what happens to him. He put MY license in jeopardy, and I've had the damn thing for less than a month.

The Gym Weeps For Me

2011-02-12T18:10:00.001-06:00

Because I haven't been in over two weeks.

Lucky for me my weight has stayed stable, which is a small miracle considering my diet as of late. I can't believe how much time my job is taking from me. Right now I'm on dayshift for the purposes of orientation and the internship.

And it is absolutely killing me. I'm having to make choices like going to the gym or see my children.

I thought I'd have so much extra time when I started working. I mean, gone were the hours of studying for exams and writing up care plans of my nursing school days. I have a list of things I want to do.

Reading, other than text books.
Writing a novel.
Plant a garden.
Do some home improvement.
Learn to play guitar.
Learn to play the bagpipes.
Learn to paint.
Actively pursue getting my photography in more galleries.
Build a tent-top camping trailer to pull behind the Jeep.
Do some upgrades on the Jeep.

My new active lifestyle meant having time for:

Camping/Backpacking trips.
At least a 5K every month.
Starting to ride a road bike and swimming so I can do my first triathlon.
More travel: Scotland, Vancouver B.C., England, Germany, Austria.

Alas, it's not to be. At least not yet. Maybe it will ease when I come off orientation.

RN-BSN

2011-02-03T19:13:00.003-06:00

It's official. I am licensed to practice in my state.

I postscripted my name with RN for the first time signing for anti-rejection meds from pharmacy. It was rather anti-climactic and the pharmacy tech didn't care.

A fitting end to one journey, and the beginning of another.

I'm loving my unit, the people I work with are top notch. Everyone is super smart and motivated. We've received our share of the crippling winter weather that grips much of the nation at the moment. When most of the city is flat shutting down, our unit is the only one in the entire 1000 bed hospital that hasn't had a call-in during the bad weather. That's a pretty good indicator of the level of commitment and the sense of duty my coworkers harbor.

I had my first patient family member give me a huge hug for the care I gave. It was a good feeling. The patient was a 46 year old CABG x5 jumps, who had never been sick a day of his life. His near heart attack was an earth shattering event for them. Judging from the way his wife clung to my neck as I was telling her goodbye after transferring them to our step down unit, I may have helped bring them some small measure of stability and hope.

Work has been exhausting due to the sheer volume of information to learn, and I haven't seen my family much because of the lengthy weather commutes. Overall though, it's been good.

When Patients Refuse to be Discharged

2011-01-29T20:10:00.008-06:00

My unit's mortality and morbidity stats suck.

But there's a reason for that, and it's no reflection on the quality of care or the competence of the staff. We take the sickest of the sick. We take the cases that nobody else will even consider. We're the dumping grounds for the private vascular hospitals in the area when things go wrong so their stats don't take the hit. There's a reason why the vascular specialty hospital across the street has some of the best M&M stats in the entire country.

When you look beyond the stats and put faces to the numbers, this translates into a good number of patients who die on our unit. And it would seem that some of those expired patients aren't ever truly discharged, if you catch what I mean...

Even if you don't believe in ghosts, it's hard to dismiss the fact that our hospital is well over a hundred years old and in that period of time, there has been one emotionally charged situation after another playing itself out within our walls on a regular basis. It would be difficult to pass off that amount of energy in such a small space without entertaining the idea that something, or someone, could end up staying behind. And there is no other unit in the hospital that sees more of this intense type of action than ours.

In short, our unit is haunted.

Every unit has that one or two beds that seem to have more than their share of deaths because highly critical or terminal patients are repeatedly assigned there. It may be because of specialized equipment available in that room, or proximity to the nurses station. It may be that it's a single bed room allowing for privacy for families to say goodbye, or a larger room that fits more pumps/machines for highly critical care.

For us, that bed is Bed 18.

Now keep in mind that the two incidents I'm about to tell you happened first hand to people that still work on the unit today. These aren't spooky campfire ghost stories handed down through the generations like some Greek mythological legend.

On our unit we don't have call lights (thank heavens!) due to the fact that there is never not at least one nurse present in any room at any given time. To communicate with each other, we use an overhead intercom system. Occasionally on night shift, if there is low enough census, several nurses have reported an unknown, but weak female's voice coming on the intercom asking for help in Bed 18, when there is no patient assigned to the room. It's happened on nights where every staff member was male...

And then...

One night shift, two nurses walked into Bed 18 to set it up for a highly critical patient coming out of surgery (heart & double lung transplant). The bed was currently unoccupied, but had a long term patient (months on the unit) expire earlier that day. When the nurses were prepping the EKG leads--attaching new pads--they noticed there was a rhythm reading on the monitor. Thinking it was another patient from another bed pulled up on that particular monitor, they tried to reset the monitor to the current bed, only to discover that it was indeed set for Bed 18. To verify, one of the nurses jiggled the EKG leads, and sure enough a corresponding artifact generated on the screen. As they watched, the rhythm deteriorated into an agonal rhythm, and then to asystole...

There are nurses on night shift that refuse to be in Bed 18 by themselves to this day...

Audited

2011-01-27T10:01:00.003-06:00

So apparently I raised some official eyebrows with my NCLEX sprint.

It turns out my test is being audited. After doing a little research, it appears that although PearsonVUE "regularly audits a random number of exams and exam results," they also hint around a closer inspection of "exams that may demonstrate signs of irregularity."

Oops.

On another note, I was finally able to take my state's online jurisprudence exam after the website was down all weekend.

Upswing

2011-01-25T22:05:00.003-06:00

I told myself I wouldn't be *that* blogger that disappeared when my internship started. But it would appear that I kind of am, since I'm typing this on my phone from the comfort of my bed. Alarm is set for the ass crack of dawn, I've been home for less than an hour.

Tonight my unit hosted a meet and greet in honor of us interns. It was truly a good time. From the comfort of the laughter and the warm glow of newly kindled friendships, it was easy to realize I very definitely made the right choice in holding out for this position. Everyone was so eager to give encouragement and advice for getting through the internship.

The internship is straight up legit. They are not messing around. The pace is not dissimilar to trying to drink from a fire hose. I am confident that I'll be successful, but I have no doubt I will be stretched to my limits. My capacity for absorbing knowledge will be tested. I cannot even imagine attempting this without the experience I already have. I can't imagine it would be anything but painful.

Just wanted everyone to know I'm alive, and doing well.

37 Minutes Flat

2011-01-22T10:34:00.002-06:00

Took a little quiz this morning. You may have heard of it...called the NCLEX.

I tried my best to not have any trepidation since it's a standardized exam, and given my track record with the HESI. I have to say though, I did get a little anxious. Probably a good thing given the ramifications.

I got to the test center about 30 minutes early--thank goodness for zero traffic on a Saturday--and there was already a line of people at the door. I pulled number 5 though when we were let in because I was observant enough to read the sign that said "Take a Number Please".

When called to the desk I presented my passport, my drivers license, and my ATT. I got photographed, fingerprinted, and palm-vein-printed. I stowed my things in a locker, subjected to a hoodie-hood search, and then was escorted to a test cubicle. I sat down, stuffed the earplugs in, and took a deep breath. Short tutorial, and then there it was, Question #1.

I forced myself to read slowly and deliberately, focusing on not rushing. Question #2 was a drip calculation, and I nearly made a mistake by trying to move slowly. At that point I said, "Screw it", and just relaxed. I fell easily into a rhythm, and just took the questions as they came. The questions weren't easy, but I didn't think they were terribly hard either. I had to think, but none of them were too difficult to reason out. I was pleasantly surprised that at least two answers of every question were blatantly wrong. There were a lot more "select all that apply" questions than I expected--maybe as much as 20%.

I wasn't keeping close track of the question numbers, and looked up just as I submitted #75... and then the screen went blue.

When I was escorted back out front, the proctors we freaking out. "Done already?! That's a new record!"

Personally I feel like HESI was more challenging because it was much more in depth and detailed on each topic. Of course I don't know for sure that I passed NCLEX yet, but I don't think I'll be losing sleep until I do get results.

One less thing to worry about.

Now to get back into the gym.

Orientation

2011-01-17T19:21:00.004-06:00

Today was my first day of hospital system orientation. Since I work for a hospital system with multiple campuses and 20,000 employees, they put on system wide orientation for all new hires at one central location.

It wasn't exactly your typical hospital orientation. Much less of the housekeeping type of stuff, and much more cheerleader type presentations. It was weird. I found myself quite bored at times while we were going over the copious power point slides all written in corporation-speak. In other words, a whole lot of words that don't really say anything. Thank goodness for the squishy man they included in our packets. Otherwise I might not have made it through without his antics...

However, the culture of the system as a whole is remarkable. 27% of employees have been there for 10 years or longer. That seems like a large percentage although I don't really have anything to compare it to. It also seems to be in line with my own personal observation during my management clinical and Capstone--every time I turned around it seemed like I was meeting someone who had been there 25-30 years.

The whole thing seemed a little unpolished and unorganized, but that's because it wasn't put on by an HR rep, but rather by two everyday employees. The idea was that anyone can come and do lip service to an organization, especially if that's what they're paid to do. However, just run of the mill employees that were just as pumped about the organization makes a statement.

On the flip side, there was a lot of support work involved too. For example, IT showed up with 25 laptops and set up a "Cyber Cafe" that was manned by an IT rep for every 2 computers to help people get logged in and work out any password issues. Very cool. Breakfast of fresh cut fruit, muffins, and bagels; lunch of baked salmon or baked chicken, rice pilaf, green beans and desert; then a cheese tray for afternoon snacks. There was an I-9 rep, there was a free gift from the hospital store. Tomorrow is the resource fair for benefits, including a wellness program that pays part of your insurance premium if you participate. Free classes by the public safety officers in defensive driving and personal protection. A system-wide credit union. Discounts through cell phone companies. The list goes on and on.

Really excited about working here!!

I'm Back!

2011-01-15T18:45:00.003-06:00

After nearly two weeks on the road, I am back. First the cruise to Mexico--amazing--and then a trip to hike the Grand Canyon--amazing!

I'll write up some details and post pictures later.

On the nursing side of things, I start orientation on Monday at my new job. Very excited for this fact. Had a minor freak out when the HR department called me on Wednesday, (when I was 1000 miles from home in spotty cell service), and told me the company they hired to do my background check couldn't verify I had a nursing degree. And I couldn't start unless I could provide them proof I'd graduated by Friday, end of business.

Uh...

So, a panicked call to my wife, and she ordered a stat official transcript Fed-Ex'd to the HR department ($24.00!!!!) so that I could start work Monday.

Other than that, things are pretty quiet.

Oh yeah. I take the NCLEX a week from today, next Saturday morning at 8 am. My ATT came by email while I was sitting in port waiting to depart on our cruise. So I hurriedly scheduled my exam as the ship was pulling out of port. Lucky for me I got it scheduled before we lost cell service.

Anyway, more posts soon!

Blame it on Mexico

2011-01-02T20:04:00.004-06:00

Wife and I are leaving bright and early tomorrow morning for our cruise.

I was going to get several posts written to post while I'm gone, but I chose to catch a stomach virus instead.

I know, selfish of me.

So, this space will be filled with dead air time until at least Saturday. Then I might get in a post or two before I leave for a week at the Grand Canyon the following Monday.

In the meantime...

Blame it on Mexico.

The Rhythm of Life

2011-01-01T14:52:00.002-06:00

Today my younger daughter asked me for a bowl of cereal, and since cinnamon Life cereal is one of her favorite things in life, I obliged. As I ambled into the kitchen she trailed along behind me, her feet padding double time on the tile as we went. First I pulled down a bowl from the cupboards, then the cereal from the pantry, and finally the rice milk from the refrigerator. As I moved around the kitchen, my daughter twirled and danced around me, her hair flipping out from her spinning, her arms and hands curving gracefully so that her fingertips just grazed the hem of her skirt. As I moved from one part of the kitchen to the next, her dancing motion was in perfect synchrony with my purposeful movements. Her tiny feet carried her around me, like a small moon around its parent planet.

I was struck by the beauty of the moment. The simplicity and the wholeness. The dance like quality.

It's a wonderful thing to be afforded these glimpses of knowing beyond the shadow of a doubt that there is no other time and space in which you belong more than this very moment.

Happy New Year.

Two Words

2010-12-31T21:56:00.002-06:00

One word for 2010: Metamorphosis

In 2010 I truly changed from the inside out. I started out as a shell of a person, beaten down and bitter, with no real niche to call my own.

Somewhere along the way I changed from a second chance nursing student to a new, but quickly growing nurse. I went from a me too tag along to a full fledged leader amongst my peers in my own right.

Even in my personal life huge changes took place. I lost over 50 pounds. My marriage solidified. I admitted to and faced my depression.

It was a long hard year, but I've changed for the better.

One word for 2011: Fulfillment

It's time to put my money where my mouth is. It's time to stretch these wings and take flight. It's time to start contributing instead of just consuming. It's time to create a means to engage all these dreams I've been chasing for so long.

So, two words.

Metamorphosis and Fulfillment

Happy New Year!

Down For The Count

2010-12-30T12:40:00.002-06:00

My family and I have had what I can only assume is the flu for the past 9 days.

It started with my oldest daughter bringing it from her mother's house and infecting us one by one. It generally started with horrendous diarrhea, moving to chills, fever, body aches, and in the kids, vomiting.

I haven't run in a week. We haven't had a full night's sleep since a week ago Tuesday. I haven't eaten more than a few crackers since Sunday. I can't stand up without graying out, and I'm in the best shape of any of us.

Right now my son is worst off--instantaneously puking up anything that touches his lips. His poor perianal area is completely excoriated from the diarrhea.

Right now we're just surviving.

We leave for our cruise Monday morning.

Maybe.

Thoughts From The Treadmill IV

2010-12-29T12:27:00.002-06:00

I am relatively certain that the flu and other assorted viri were bio-engineered by laundry detergent manufacturers. The amount of laundry generated by these viri in soiled bedclothes and pajamas is staggering.

Christmas 2010

2010-12-26T00:55:00.011-06:00

Christmas Eve was a flurry of activity. I started the day with a 6 am grocery run, and it worked out perfectly. Not only did I beat the rain (we had a 100% chance forecast), but I also beat the feeding frenzy that usually happens the day before holidays at the grocery stores around here. I took a short nap after I got home from the grocery store, and then got in a good run at the gym before they closed at 3. Somewhere in there it started a cold, cold rain outside. We had planned on going to Christmas Eve services at our church, but my younger daughter had a stomach virus that moved south, further along in her GI track that made close proximity to a private bathroom a necessity--poor thing! So we stayed home and made cookies for Santa and watched Polar Express instead. The kids left a plate out on the mantle for Santa with cookies, and a few carrots for his reindeer. After the kids were finally down for the count in their beds, it was darn near 11 pm. My wife and I started wrapping presents at that point, and munching on Santa's cookies so the kids would think he had dropped in, while the rain continued to pour down outside.

Christmas morning dawned clear and windy, and chilly. The kids actually let us sleep until about 8 am, with my younger daughter up first. She came busting into our bedroom, "Santa came! There's presents under the tree!" Then she went sprinting back out into the living room to check on the cookies and stockings, only to come running back into our bedroom. "Santa came! He really, really came!!" She was so excited--completely heartwarming to see her joy. It wasn't long after that that we let her get the other two kids up. Once everyone was assembled in the living room, we read the Christmas story from the Bible, to help keep things in perspective. And then it was present time. As you can see, opening presents is a very serious business around here.

My son received his first wooden train set, which he played with for a good hour after getting it set up--pretty focused for a 2 year old who won't sit through 30 minute TV show.

My younger daughter received Disney Fairy goods--both the Fairies themselves, and their animal sidekicks. She was completely over the moon with them.

My oldest daughter only received a very small package from Santa. But she was OK with that when she discovered it contained a pink iPod Shuffle--her first mp3 player.

The kids got my wife a cute little ring from James Avery, and I got a Kelty internal frame backpack for my trip to the Grand Canyon in a couple weeks.

Once presents were opened, I started in on our Christmas meal. I didn't do much, because it was just our small family this year. Usually I'm cooking for 18-20 with my wife's family who live near us. However, her family was traveling to Wisconsin this year to attend a wedding, and spent Christmas up there instead. It was kind of nice to have our little family all to ourselves this year. I served Earl Campbell sausages (haha!), cornbread stuffing, rosemary potatoes, tropical & citrus fruit salad, and green romaine salad. We had sweet potato pie for dessert.

After lunch, I helped my daughter sync her iPod, and then helped my wife create a new workout playlist. Then it was time to get the kids down for naps, and my wife rested a little bit since she was going to work. She was scheduled to work Christmas Eve, and Christmas Day, but their census was low enough that she got canceled for Christmas Eve, and split a shift for Christmas Day night. It was really nice having the whole family together for the holiday.

What did you do? What did Santa bring you?

Happy Christmas All!

2010-12-23T19:15:00.000-06:00

Pinning Ceremony

2010-12-17T19:25:00.011-06:00

Next up in the Graduation-Season-Gala-Extravaganza-Event was our pinning ceremony. As you can tell from the left there, I finally made it to the big screen. The 100" plasma screens at my church that is. Our pinning event was held in my church building, mostly because I was able to negotiate an amazing deal on the cost, and as a venue it was pretty much perfect. It was a big point of contention that the school itself (because pinning is not a school supported event) was going to charge us ~~out the ass~~ to use their facilities. On top of that, if we held it at the school, on top of the rental fees, the audio-visual department within the nursing school would have to provide their services for a ~~mandatory fat payment~~ suggested donation of $1000. Given their track record, I we didn't want them to have any part of our ceremony. Not to mention the principle of paying to use facilities at an institution we'd just paid $40,000+ to, to earn the degree in the first place. Thankfully because I'm good friends with the facilities manager at our church, we got an amazing buddy deal. Full venue with professional audio-visual for a mere pittance over what just the audio-visual would have cost us at the school.

I gave my speech pretty much verbatim as posted here, save for a few added inside jokes (thanks for the suggestion Will). I also took the opportunity (and advantage of having a microphone) to tell my wife that I loved her when I made the point that we needed to tell those we love that we love them. I have it on good word from those that she was seated next to that it brought some tears to her eyes (mission accomplished). The speech went over well, and I received many compliments from families of classmates--complete strangers--as well as classmates and faculty. I enjoyed being up in front of so many people, and mercifully I wasn't the least bit nervous.

Here is my lovely wife pinning me on stage to the tune of Coldplay's Life in Technicolor. I really was privileged to be pinned by someone I love so much, who also happens to be an RN and working member of the profession. I even caught her getting a little teary eyed as she pinned me.

My service to the pinning committee was providing the venue, the heavy lifting, and the occasional reality check to the estrogen infused pinning committee meetings. There were essentially two other people that bore the brunt of the rest of the organizational duties, and they did an amazing job. The faculty present gave several comments to how nice our ceremony was, and how much they enjoyed it. The entire ceremony went off with only a minor hitch or two, which was gratifying considering the amount of work involved.

Overall I'm glad I was involved as I was in the planning and execution of this event. In the past I wouldn't have bothered with something so inane and peckish. I hope that's a sign that I'm really going to take to this nursing thing.

Sigma Theta Tau Induction

2010-12-17T10:56:00.006-06:00

The whole Graduation-Season-Gala-Extravaganza-Event was kicked off on Wednesday evening with my Sigma Theta Tau Induction ceremony. Yet again a masterpiece of misinformation and lack of communication. We were told the event started at 1630, only to arrive and discover it actually started at 1700 and was running behind, so more like 1730. We had left the kids unfed at home with my parents and sister (who had just arrived in town a couple hours before), because we were sure we'd be home by 1800 or 1830 in time to get them their dinner. Some hurried instructions by text and the kids were provided for so my parents and sister didn't have to deal with hungry-cranky kids.

The ceremony was nice. It was even more nice to see my friends from school that I hadn't seen in awhile because of Capstone. And especially nice to hear that one of my best friends and study partners got a job on the same unit as me at Gargantuan Hospital. I'm so very grateful to be going through the critical care internship and orientation with an already established friend and study partner. I have to say I'm much more confident going into this with my tried and true study crew. (She's the one standing next to me in the picture there on the right.)

When it came time to be "corded" various members of the faculty were rotating through, cording each of us after we were handed our membership packet. When it was my turn, who should be the next faculty in line? The only faculty member I've gone to the Dean about because she physically threatened me when I questioned a quiz question in class, and then later kicked me out of her office when I tried to reconcile the situation during office hours.

Nice.

She just hung back, refusing to cord me. So a really awkward situation resulted, and I ended up being corded by someone I've never taken a class from.

Whatever.

Interesting to note, my wife immediately recognized this faculty member from her own days as a student at our CON. My wife received clinical excellence awards for every clinical she was a part of...except for the one led by this faculty member. She was the only faculty member that my wife (the most ultimate get-alonger ever!) had an issue with her entire nursing school experience. So it runs in the family apparently. Her class called this faculty member "The Wicked Witch of the __________" (Fill in whatever direction you're facing at the time).

It was a very nice ceremony though, and I appreciate the honor.

(Although the keynote speaker mentioned that Sigma Theta Tau was like the Ya-Ya Sisterhood of nursing--yay me!)

Prayers for a Sweet, Sweet Friend

2010-12-15T22:49:00.003-06:00

Many of you that read this blog also read Running Wildly. She is absolutely one of my very favorite bloggers that I've had the pleasure to read.

Her quiet encouragement at just the right times--a small comment on a post of mine, or a timely post of her own on a very pertinent subject--have helped sustain me, lift me, and carry me through nursing school.

The amazing weight-loss journey I've been on? Inspired by her as she coached and coaxed friends of hers to run a 10K with her. Then she stayed involved even after a training-ending injury, even showing up on race day to cheer on her friends. She is the reason I stepped onto the treadmill that first time however many hundreds of miles ago now.

I love her for the way she lives with wild abandon, Running Wildly through life as a child of God. I love her because of the way she loves her husband and her gorgeous children. I love the way she fairly radiates pure, unadulterated "nurseness". She is all that is right about the nursing profession. She is one of the good guys.

But now she is facing excruciatingly scary news. And in the face of horridly fearful news she speaks of God's glory, and God's plan, and her faith.

Please, if can spare even a small quiet moment, send a prayer up for RW. I would appreciate it, and I know that she would as well.

RW, even though we've never met, please know that you've been an integral part of my nursing school experience. Thank you so very much for everything. I think you're an amazing person!

Captcha Ninjas

2010-12-12T18:55:00.001-06:00

So, a word or two about comments.

First of all, I'm extremely grateful to all of you who take the time to read my blog. It really makes my day when I get comments, and it makes me feel good that people care about what I say and write.

On the other hand, as much as I love getting and reading comments, I'm just as terrible about responding to them. Please know that your comments are valued much more than my lack of responses indicate. I will try to do better. Hmm a New Years resolution maybe?

While we're on the subject, I have some comment commentary: Don't you just hate Captcha? I mean I get why it exists, and I don't fault those who use it, but man it can be annoying. Sometimes they spell words that are funny or a little dirty, but mostly they're just annoying.

The worst of the lot are the Captcha Ninjas. You know them, they are the comment forms that allow you to type in your comment, hit submit, and then.... Wham! Out of nowhere the Captcha Ninja pops up and strikes.

I much prefer the comment forms that let you know up front they're packin' a Captcha. It's nice to know what you're getting yourself into from the start. This way you can gauge if what you've got to say is really important enough to deal with a Captcha form.

So I don't use Captcha on my blog. It's not like I'm so overrun with spam that I can't handle things with comment moderation. NurseXY is a proudly Captcha free zone, so comment away.

But don't let down your guard...you never know when those infernal Captcha Ninjas might attack.

Numbers

2010-12-11T18:39:00.001-06:00

1--One week until graduation.

3--Three weeks until we leave for our cruise.

4--The number of children 5 and under currently terrorizing our house right now. We're watching some friends' children while they attend parenting classes in the process of adopting a 3rd child.

17--As in January 17th. My official start date for my new job.

19.4--Miles to hike in and out of the Grand Canyon the week between the cruise and starting work.

27--The number of pounds left to lose before the USAF will pay for CRNA school and pay me a salary while I'm in school, in exchange for 3 years of service.

49--The number of pounds I've lost to date.

235--Current weight, after ballooning up to 241 from 237, and then back down.

Two Years Ago Today...

2010-12-10T13:33:00.012-06:00

...the heavens opened and sent us a little devil of an angel. (Probably they were relieved to get him out of the big house before anything else got broken.)

I remember that my wife started contracting about 11 am, but we thought she was just having Braxton-Hicks-ish contractions. They kept up all afternoon, and by the time we headed to Target that evening around 6, she was having to concentrate on them as they passed. At that point we realized probably this was for real, but thought we had hours and hours to go. She sent me off to Baby's-R-Us to buy a piece of furniture with a 20% off coupon that was about to expire, and when I got home at 8:30, she let me know she just couldn't take it anymore. The contractions were becoming painful.

Reluctantly we decided we'd head to the hospital after calling some friends over to watch the other kids. We were both sure that the longer we were at the hospital before delivery, the more likely we'd end up with an intervention filled birth--exactly what we didn't want. We left about 9:30 pm, and when we got to the L&D unit about 10, it was a madhouse. I don't remember if there was a full moon, but that's the type of night they were having. When someone finally triaged us, I'm sure it was probably the 8 or 10th person she'd assessed, and she was a little bit cranky.

When the nurse assessed my wife's cervix, we were sure she'd be dilated to a 2 or so, and we'd have hours of waiting. Surprise, she was a 6 on the conservative side, probably further along than that judging from the look on the nurse's face and the speed with which we got a room. She got a line in (second try after blowing the garden hose in my wife's hand--sucks to put IV's in on a nurse, haha!) and started LR. The nurse trundled off to call our midwife. My wife was starting to panic, completely sure she wouldn't be able to bear the pain, and requested an epidural. Of course until the liter of LR bolused in, there would be no epidural.

And then her water broke.

Not that it mattered, there was no CRNA or anesthesiologist anywhere to be found--they were just as far in the weeds as the nurses.

It was less than an hour later that my wife told the nurse it was time to start pushing. The nurse asked that she wait for the midwife, to which my wife sweetly and politely replied that it was time to push, NOW.

The nurse checked her, and judging from the way she bolted to the door and bellowed for the midwife, my son must have been at about a +4 station. The midwife showed up within minutes and asked my wife to take a test push. Since he was crowning, they decided she was ready to push after all.

One push, and his head was delivered.

One more push, and his long body came splooshing after.

And in that moment, 11:20 pm, the world beyond the walls of that room ceased to exist. His small squishy, wrinkly form, that I had longed to see for 38 long weeks was right before me. That tiny little heart beating as fast as it could just to pump my overwhelming love through his veins pulsed under my fingertips as I touched his chest for the first time. The roaring in my ears had to have been the sound of my soul stretching and expanding exponentially to accommodate another being for which my love is boundless.

My beautiful wife was exhausted and had pretty extensive tearing from delivering him so quickly. The midwife was repairing her perineum, so I was standing guard over my son at the warmer while they assessed him.

8 lbs 13 oz, 21.5" long. And all boy.

Counting toes:

Three months:

Six months:

One year:

20 months:

The family:

Happy birthday son.

I love you.

Pinning Speech (or, All I Really Need to Know, I Learned in Nursing School)

2010-12-09T13:19:00.004-06:00

Remember my Sally Fields moment? Well here is the bulk of the text of my planned pinning ceremony speech. I'd love to hear what you all think. (Unless you think it sucks, in which case don't tell me it sucks, just tell me I might consider going back to the drawing board...). My pinning ceremony is the morning of December 16, just a week away. Graduation is that night.

As we draw close to the end of nursing school I find myself looking back over our time here. Now granted we’ve all lived from test to test, from memorizing each drug to the next, and from one disease to yet another pathology. Nursing school is clearly about taking care of patients and helping people get better, or not get better with dignity. But somehow I can’t shake the feeling that nursing school is about so much more than that. If we boil it down to the very simplest terms, some sort of academic red wine reduction sauce, nursing school is about, well, life.

Now that thought immediately brought to my mind the famous poem by Robert Fulghum, “All I Really Need to Know I Learned in Kindergarten”, which is of course, pure genius. I rather like the view from the shoulders of giants, so I give you, “All I Really Need to Know I Learned in Nursing School.”

1. A bath and a tidy bed will make anyone feel better. I’ve seen it time and again, simply straightening a patient’s bed invariably elicits the comment from a family member, “Oh, they look so much better today.” This isn’t any less true in the rest of life. Stressed out? Overwhelmed? So much to do that you just don’t know where to even begin? Make your bed. Bad day? Overworked? Stretched to your absolute breaking point? Take a bath. You’ll feel better on both accounts, I guarantee it.

2. There are few things better in life than a good nap, a good meal, and a good poop. As nurses, if our patients are eating, sleeping, and pooping, their prognosis is pretty good. In the larger picture, when we came into this life, eating, sleeping, and pooping were first three things we did, and I’m pretty sure we got it right.

3. Speaking of poop…it happens. Ignoring it doesn’t make it go away. Or smell better. It’s best to simply clean it up and move on. Remember, very few people aren’t completely mortified when their own poop comes to light—always, always do your best preserve their dignity. Apply that to the poopy things that come your way in life, and it still rings true.

4. Always keep careful track of what goes in, and what comes out. Balance is a good thing. We all had I&Os for our patients drilled into our heads in class and clinicals, but this applies to so many things: bank accounts, raising kids, our minds and our mouths. Think about it. Don’t spend more than you have. Fill your children with the good things in life and you’ll never worry about what will become of them. Fill your own minds with truth and knowledge, and the words that you speak will never embarrass you.

5. Assess the patient, not the monitor. How many of us have gone sprinting into a patient room because the monitor was showing a lethal rhythm or an ugly 02 sat, only to discover the patient sitting up and laughing in bed? In real life, people may have impressive resumes—a litany of accomplishments and achievements, but that should never substitute for your own assessment of their character. Listen to your gut, it’s almost always right.

6. Details matter. Write things down. Time and again I hear people say how much it’s the little things that make a difference. Remembering the small things will make you a hero to most people. Keep a journal, and occasionally read over it. A little self-clarity can never be a bad thing. Every major change begins with one tiny detail that’s altered.

7. You don’t always have to wear gloves when you touch people. We talked about this in class—that human touch means so much to patients. We’ve learned the value of therapeutic touch, but again, this applies to even more so to real life. When we open ourselves up to people, we truly begin to experience the beauty of human relationships. When we leave our protective barriers behind and take off our gloves, we are truly able to receive—and give—love.

8. Sometimes it’s just time to let go. Who hasn’t taken care of a patient who we all know will never get better. The patient suffers, and the end result is the same. In life how many times do we go down the same road, making the same decisions, expecting a different result? Sometimes it’s just time to let go.

9. Always ask for help when you need it. As we transition from nursing school to real life practice, most of us will feel like we have so much to learn yet. Something I’ve learned in my short years on this earth is this: When we get right down to it, people love to help each other. Helping one another makes us feel good. Allowing someone to help is often just as beneficial for the helper. Again this goes back to allowing ourselves to be vulnerable, and admitting that maybe we could make it on our own, but it would be so much easier if we just allow someone to help us.

10. Tell the people you love that you love them. I know that in clinical at some point during nursing school we’ve been party to a patient dying unexpectedly. Gone before their time, or passing on before family can make it to the bedside. As nurses we have the privilege of being present for births, and for deaths, and nearly every kind of moment in between. We should take the lessons we learn from our experiences with others lives. Be sure that you tell the people you love that you love them.

And so here we stand at the close of one journey, and on the verge of another. Through the years, each of the 4 semesters, the 6 am clinicals, the exams, the OSCE’s, Assignments 1, 2, and 3, we’ve grown together to be a family. Oh sure, we each have some of us that we can’t hardly stand to be around, but we are family nonetheless. I want to thank each of you for the privilege of making this journey with you.

Well done Class of December 2010, and best of luck with the future.

The Great Laude Wars

2010-12-08T19:36:00.005-06:00

One of the things I've been looking forward to the most about graduation has been Latin honors. I've always been more than capable of excelling academically, I just never really cared to. The effort required to track every grade percentage point just hasn't seemed worth it to me in the past.

For example, of my high school class of more than 800 students I graduated only at #24, all the while tutoring both the valedictorian and salutatorian in math and physics. If I'd only taken the trouble to turn everything in, I'd have easily challenged them both for their positions.

To me though, it was much easier to rock the evaluation exams than to do the day to day drudgery of homework and coursework. Hence my 36/36 perfect score on the ACT when I took it my senior year in high school. The trend continued when I got into college. The exams that blew everyone else away, I was that person that blew the curve for everyone. I consistently performed at high B/low A level, regardless of the difficulty of the exam. I lost points not for lack of knowledge or understanding of concepts, but rather for housekeeping details that I just didn't bother to read or attend class to hear. This style of ill-preparation and poor class attendance earned me a stellar 3.2 GPA in my first undergraduate degree.

When I graduated with my BS in Biology, I decided I wanted to go to medical school. Clearly a 3.2 GPA wasn't going to get me noticed by any medical school in the continental US, so I knew I'd have to rock the MCAT to even have a chance. That was probably the most legit exam I've ever taken, and I only scored a 29 the first time out. A decent score, but hardly earth-shattering especially combined with my crappy GPA. I buckled down, actually studied, and scored a 38. That score generated some interest from the schools, but I ultimately decided against going to medical school.

So when I came to nursing school, I made a decision from the outset that I was going to do the work. If I was going to take this second chance, I was going to do it right.

And so I did.

I kept track of every little percentage point. I obsessed over assignments. I studied for exams I knew I could pass without trying in search of those extra 8-10 points. I had a few bumps in the road, like when my son was born at 11:20 pm the night before my pharmacology final, and I got less than 2 hours of sleep. The final dropped most people a letter grade it was so ridiculously hard, and I was no exception. I ended up with a B. Then there was the research teacher that decided I was Satan's spawn and through the subjective grading of research analysis papers, orchestrated me receiving a B by less that 0.02 points. I talked it over with my wife, and we decided I wouldn't grant the instructor the satisfaction of seeing me worked up over it, so I let it go without challenging it. In the end I have a 3.88 GPA for nursing school, and achievement I'm quite proud of.

Imagine my surprise when I found out I would not be graduating with Latin honors. You see, when I entered nursing school, they automatically upgraded the catalog under which I would be taking classes, regardless of the catalog under which I first entered the university. They also updated the requirements for Latin honors. Previously it had been either an overall GPA over 3.5, or the last 45 hours over a 3.5. The new requirements require both an overall GPA greater than 3.5, and the last 45 hours over a 3.5. Not only that, they would calculate overall GPA from every hour ever taken at the university, not just the hours applied toward the current degree.

And so that 3.2 overall came back around to haunt me. Clearly my own fault, but people change. And I have dramatically.

If only the hours being used for the current degree were calculated, I easily had the >3.5 overall required. And my last 45 were way above requirement. Additionally, if I had transferred in to attend nursing school from an outside university, all that GPA would be wiped clean--lost in transfer credit hours. So because I chose to be loyal to university, I get penalized.

I decided that being a nurse was all about being an advocate, and I was going to start by advocating for myself. I made an appointment with the assistant registrar/graduation counselor. She refused to consider my points, and was actually quite rude. So I made an appointment with her boss, and in the meantime wrote the following email to the deans of my nursing school:

Dear Dean HeadHoncho & Dean FirstAssistant:

When I first came to ### in the Fall of 1998 in pursuit of my first Bachelor's degree, I was young and unfocused. It showed in my grades--yet still I managed to eke out a 3.2 overall GPA when I graduated with a BS in Biology in 2001. Nine years later as I am about to graduate ###CON's BSN program, I am older, more mature, and much more focused. As a result, at the end of this semester I will have over a 3.8 over the last 45 hours--the criteria used to award Latin honors. Mind you, I did this with a job, 3 children, no daycare and wife that works full time nights as a nurse.

Unfortunately due to arbitrarily having my catalog year reassigned when I entered the nursing program, my overall GPA doesn't qualify me for Latin honors. However, if I had done my prior coursework at another college, those hours would not count toward my overall GPA, and I would easily qualify for Latin honors. This seems a bit unfair to me, and rather unfortunate. Because I chose to stay loyal to ###, I am being penalized by not receiving Latin honors.

I came to nursing school for the sole purpose of gaining my BSN so I could continue on to grad school. I would love to stay in the ###CON program, however since my undergraduate overall GPA will continue to haunt me, I just don't see that as a possibility any longer. I refuse to patronize a learning institution that endorses a double standard for its students, refuses to reward students for institutional loyalty, and arbitrarily changes the rules as it deems convenient.

I know that you have no direct control over who receives Latin honors, but I thought you should be aware of the fact that you will be losing at least one well-qualified student from the pool of potential graduate students. NP? DNP? PhD? Who knows how far I would have gone. I feel you also should be aware that people like me, loyal to ###, are being treated differently than someone who hasn't worked any harder than me, but will be rewarded for disguising their overall GPA in transfer classes.

I'd be happy to entertain your thoughts on the situation. I am currently working the chain of command to try and resolve the issue on my own--now making an appointment with HeadHoncho Registrar.

Regards,

NurseXY

Something I said must have lit a fire somewhere, because by the time I attended my appointment with the registrar the next morning, the Dean had already written an email forwarding my email on to him. Oddly enough, they found it appropriate to return me to my original catalog year (which never should have been changed), and suddenly I qualify for Latin honors. Magna cum laude in fact.

However, as the assistant registrar/graduation counselor rather gleefully told me, it doesn't matter because the programs have already gone to print so it can't be changed to reflect my honors.

But it matters to me.

And it will matter on my CRNA school applications.

I had purchased honors cords when I bought my cap & gown a couple of months ago. And you can bet your tassel I'm going to wear them during graduation.

I Think I'm Addicted...

2010-12-07T13:55:00.000-06:00

...to running that is.

This past Saturday I ran my second 5k, nine days after my first 5k ever. I was a little worried about the weather because a cold front was pushing through. I don't really care about the temperature, but cold fronts around here bring wind, and lots of it. When you're my size and have roughly the aerodynamics of a barn, wind can be a race killer. But a little before race time not only was the temperature in the balmy 50s, there was no wind.

I got in line to pick up my race packet an hour before the starting horn and the line was seriously long, but the people around me were friendly. The time passed quickly and I soon had my race packet in hand. I then headed to the port-a-john. And that's where things went bad.

The grass was wet from the morning mist, and so the floor of the port-a-john was a sloppy toxic mess. There was nowhere to set my race packet while I took care of business. In a flash of brilliance, I opened the door and set my packet down on the ground just outside the door. When I was done, I re-emerged to find someone had stolen my packet.

It was now less than 5 minutes from start time. By the time I found a race official, I barely had time to pin on a non-numbered bib and scribble down my name and address for them to send me an extra shirt if they have any extras. I was seriously pissed, but the starter horn was going off, so I tried to put it all out of my mind and started running.

I started near the back of the pack, and as a result I had my work cut out for me dodging strollers and gaggles of walkers. Before I realized it, I was passing the 1 mile marker. I tried settling into a rhythm but the pace that felt comfortable was way too fast, and I knew I wouldn't be able to maintain it--I was running about an 8 minute mile pace!

The 2 mile marker I was really hurting, and so I made the decision to walk a minute or two, knowing I have a real problem getting started again after walking. I walked for 2 minutes and forced myself to start running again. I pushed onward and finished in 28:44.4 according to RunKeeper on my phone. Since my race timer was in my race packet. That's the real bummer, no official time.

It's almost a 5 minute improvement over previous race. I had a coughing attack after finishing, so I'm not entirely convinced I'm 100% yet.

All in all, I'm happy. I'll take it.

Professional Distance

2010-12-05T19:27:00.001-06:00

One of my favorite bloggers, New nurse, in the hood (NNITH) has a really touching post, Haunted up over at her blog. I immediately wanted to comment, but as I started composing my thoughts I realized there was so much more to be said than should be left in a comment box.

I'm coming up on a year of work experience in an ICU, and I've made my way through all the clinicals associated with nursing school. All of that, though hard-won experience, isn't terribly impressive, and really I'm still just a baby as far as my nursing career goes. But, I have been around long enough to know that sometimes, certain patients just stick with you long after shift's end.

In school we were counseled on getting too close to our patients. We were told to maintain a professional demeanor, a professional distance, a certain detachment from our patients. This was necessary to protect the patients, and to protect ourselves. You see, we need to remain objective so as not to miss some critical sign or symptom. So as not to be blinded as to what is truly best for the patient. So that we can continue to function in highly stressful situations, and deliver the same standard of care to all whether through good news or bad.

Admirable advice really.

And I think it's a load of crap.

I work in an ICU. People come through our unit on a regular basis, and when you're a patient in the ICU it's generally for a reason. We don't typically see a lot of stubbed toes or sunburns--our patients are sick. Nearly all of them. Some are sicker than others, but everyone has the potential to backslide right down to death's door. Others claw their way back towards health, and I think it's our job to give them a hand up. Or sometimes let them know it's ok to just let go. I see so many gravely ill people that their faces and cases have already started to blend together a bit. The rooms in an ICU are witness to life-altering scenes, and when the patients are gone, the room gets cleaned--a set of fresh linens, and a liberal dose of CHG to wash away the tears and pain. Then, a new patient arrives, and we begin it all again.

I treat every patient with the same standard of care. I am equally conscientious, engaged, and caring, regardless. But the memory of some of them slips away to join my collective experience of the unit. Not individual anymore to me, but part of the background ambiance, or aura, if you will.

But others remain with me, their faces clear as day, dancing just at the edge of my vision in that moment between sleep and wakefulness. Their whispers still echo in my ears in the quiet moments, and I've come to realize their stories are firmly entwined in my heart--a part of my life experience.

I believe that patients like these are put in our path to teach us lessons. Sure, we may be the one to provide the patient care, to serve them, to fight for their well-being on their behalf when they simply cannot. But the true service comes from the lessons we learn about ourselves from them.

The emotions from losing the older gentleman patient that NNITH has written about haunt her in a very real, very painful way. But I guarantee she went home and told the people she cares for that she loves them.

It seems a terrible price to pay for life's lessons; to be haunted in a such a way. But are any of life's lessons worth knowing any less expensive?

We risk being hurt when we care. It's the price of admission of letting yourself be vulnerable. Opening ourselves to experience joy and love leaves us unguarded to pain and suffering as well.

As nurses we routinely intersect people's lives at times when they are in full-on crisis. They are frightened and angry. When we put ourselves in the path of these times and places, it's not unforeseen that they will begin to affect us.

So NNITH, please don't stop caring. I respect you because of the compassion you show for your patients. I respect you for your intolerance to bullshit when people come into your ED to waste everyone's time, and to steal attention and resources away from those that actually need it. I respect you for being affected when life happens in front of you, and you allow yourself to be a part of it, and to ultimately allow your soul to be touched.

I think you're an amazing nurse.

Humbled

2010-12-04T15:09:00.000-06:00

As I mentioned in previous posts, I have been offered an amazing job. I have been accepted into the critical care internship at Gargantuan Hospital. Gargantuan is a Level I trauma center with over 1000 beds. My home unit will be the coveted CVICU. This is THE job I said I would turn down any other offer for.

Looking back over the journey I've taken to get here--from the depths of despair as a chiropractor unable to even provide for his family to a new grad nurse intern on one of the top units in one of the best hospitals in the country--I am struck by how visible the hand of God is in all this to me.

I know several of my readers are atheist or polytheist, so I hope this post doesn't come across as too preachy. That isn't the intent at all but my Christian faith is a very important aspect of who I am, so I feel I need to record this experience as I've lived it.

It's been no secret that I've schemed and planned to get this job for months--actually over a year and a half now. From the moment I heard about my externship in my Jr. I semester, I coveted it. I sought out the manager after spending the day on the unit as an "off unit experience" for my Jr. I clinical. I made my case for wanting the externship, and he told me to email him the following October when the position was posted.

I cultivated a friendship with a student a year ahead of me who was currently in the externship. Granted we have much in common, and he truly is a good friend now, but my purpose in the beginning was to open doors for me.

When the time came, the extern position was posted for only 2 days, and I was offered the position even before the end of the interview. I had secured the job before anyone else in my class at school even knew the position existed. I vowed to keep an open mind and considered staying on at that unit after graduation, but really the whole reason to work there was to gain valuable experience on an ICU so I could move on to a bigger hospital and a bigger unit. I wanted all this within the educational confines of an externship rather than working entirely as a grunt tech. The experience I gained was invaluable. I learned and did things that many working RN's don't know how to do.

I schemed and pleaded my case to get into the clinicals that would pave the way to such a desired position after graduation. I suffered through Med Surg clinicals at a large county hospital to be able to put the name on my resume. Before Sr. I semester even started, I uncovered who my clinical instructor for critical care would be and I wrote emails to her to ensure I got placed in the CVICU at Level II hospital, again for the name drop on the resume, and to build relationships to possible secure a position after graduation. For Sr. II, I again scrambled and plead my case and managed to get into management and Capstone clinicals at the only large hospital on the clinical list for that semester (Gargantuan Hospital). Only 10 of us out of 110 students got into that clinical group--but it was a must-have because Gargantuan Hospital has a reputation for hiring out of Capstone.

I worked my ass off to keep a high GPA in classes that I could have simply passed without studying at all, with no work at all. I joined professional organizations and attended meetings. I spent time doing community service through volunteer work. I volunteered to work as a standardized patient for an ACLS class, missing a baseball game with my family, because the class was sponsored by Gargantuan Hospital and I would have the chance to interact with the education department.

Only God knows how many prayers went his way regarding my employment.

And through it all, God has simply directed things and made it all fall into place in an eerie sequence of events. Happenings that don't seem to make sense at all, and lead me to believe that someone has been watching over me with a greater purpose for my life.

For example--remember Amazing Children's Medical Center? I applied for their summer externship position. The person I interviewed with all but handed me the position during interview, saying, "If any other hospital offers you a position, be sure you call me first." I canceled a family vacation and didn't sign up for summer classes because I firmly believed I would be getting an offer from them. You may remember that no job offer came. Others in my class were selected instead. And I was devastated. That program was supposed to lead to a job for me after graduation.

And you remember me applying for Level II's critical care internship a month ago? One of the panel members I interviewed with was actually the manager of the unit where I did my critical care clinical--one who approached me at that time to find out my plans post graduation. I rubbed elbows with the ICU managers during a recruiting event, and I had an awesome interview. I fully expected a job offer. And I did not get one, while others in my class did. People that I couldn't understand why would be selected above me.

But God knew just what he was doing.

Amazing Children's Medical Center? They still haven't interviewed for their critical care internship. In fact I've heard through the grapevine that they haven't even nailed down a budget for their interns yet, so they don't even know if they are hiring anyone. The people hired into their externship are still waiting to know if they'll have jobs or not. Meanwhile other hospitals are hiring and filling their positions. They'll be sifting through leftovers if they aren't offered the jobs they were all but promised.

And the Level II internship? The people they've chosen to fill the positions speaks poorly of the entire hospital. Certainly not people I would trust to work near, let alone depend on to have my back in tough situations. That's not even mentioning whether I'd allow them anywhere near a loved one in a health crisis.

In fact, I was recently rejected even by the large county hospital. A hospital that's so desperate for nurses they are giving out sign on bonuses in this economy. And they didn't even bother to interview me.

And so God has orchestrated my hiring into an amazing hospital, onto a prestigious unit. A place with an amazing culture where it seems every time you turn around, you meet an employee who has been there for 20+ years. A hospital with such a great reputation in the community that I have never heard anything but good things about it.

More importantly, God allowed me to scheme and plan. He allowed me to beat my head against the wall. And then, when there was nothing left for me to do--when I had exhausted all my human antics and vain attempts--he simply put me where he'd planned for me to be all along.

A week before I interviewed for my new job, the manager wasn't planning on hiring anyone--their census had been too low. But when the numbers for the last quarter came through, their census had picked up so much there was room for not only me, but another new grad as well. If that isn't a sign of God's abundance and provision, I don't know what is--he provided twice what was needed.

And so I here I am. Broken and humbled. And well cared for.

My grades, my work experience, my resume, and my networking may be the justification for my hiring, but I know quite deeply that they are not the reasons why.

Content

2010-12-01T08:11:00.003-06:00

I've been whittling away at my 8 12-hour Capstone night shifts on the Transplant ICU at Gargantuan hospital. As of this morning I've done 5 of the 8. I'm back again for the next 2 nights, and then a chaser shift on the 7th. At that point I will have completed all the requirements of my nursing school for graduation.

Transplant ICU has been interesting. I have a really great preceptor--so laid back--we fit perfectly. I've felt good about my contributions to the unit, and it's been great learning another aspect of ICU nursing.

In fact, this morning as I was leaving from shift #5, I found myself reflecting on the state of my life at this point, and a sense of well-being washed over me. The air was chilly, and the sun was just coming up. I was snuggled inside my college of nursing hoodie, and walking to the remote parking felt good.

I suddenly realized, I love my little ICU world. I love micro-managing my patient's care, and controlling every vital parameter. I love that the difference between doing well and crumping can be just a few mg/dL, or a few mmols. I love things as simple as writing vitals every hour, putting my mark on the chart stating, "I assessed this patient this hour, and things were good," or "things weren't so good so I..." I love that when patients go bad on the floor, they come down to me. I love the look of relief on the floor nurse's face when I take over responsibility for the patient's care. I love that docs ask me what I think the patient needs, and 9 times out of 10 they're on board with me. I love these things.

I love that I'm almost done with school. I love that the school and professors have thrown their worst at me, and I've met every challenge head on and succeeded. I love that I've excelled not only in classes, but in clinicals even more so.

I love that I have a job waiting for me. That I beat out 758 applicants that had been screened over the phone. I love the tone of respect in other people's voices when they hear which hospital I've been hired into, because it is truly a fantastic organization. I love the tone of respect in other nurse's voices when they talk about my home unit. I heard a Transplant ICU nurse say that on my home unit, "All the nurses are oddly intense."

I love that my wife truly gets what I'll be doing for a living. I love that I can complain about docs or nurses or lab or RTs and she understands why I'm frustrated. I love that I can throw out a set of vitals or lab values and she's appropriately shocked or mystified without me having to explain it.

Most of all, I love that my little, beautiful family is still gathered tightly around me despite the journey I've been on. I love that the kids still scream "DADDY!!!!" when I come home. I love that my wife kisses me and says, "Good job."

Life is good.

The Day After

2010-11-26T12:51:00.003-06:00

Thank you for all the supportive comments on yesterdays post. I truly appreciate them. I know I'm super hard on myself. Always have been. Fatal flaw? Maybe.

I made myself get up off my tail and go to the gym today, mostly because I signed up for another 5K next Saturday, haha! I want another shot at it!

Workout went pretty well, and it was good for me. I was able to tell that the cold really is pulling me down, as on the ultra-measurable treadmill, I wasn't able to hit hit marks I've hit before. I did manage 25 minutes at a 9:15 pace, but I've previously run 30 at that pace, and wasn't wiped like I am today after just the 25. I started coughing and hacking and had to walk the rest of my workout.

I'll take tomorrow off, run Sunday and Monday, rest Tuesday, run Wednesday and Thursday, rest Friday, and race on Saturday. Hoping I'll be much improved by then. I'm also hoping to move at least half those workouts outside. Much different running outside than on the treadmill, and I'm positive that was working against me too. Slightly different muscles I think.

My wife and I were silly and got up for Black Friday sales. We got to Kohl's by 0330 and the parking lot was full. Once we were inside we were able to locate our items fairly quickly though. Then we went to get in line to check out. The checkout ran from the registers at the front of the store, all the way to the back of the store, then doubled on itself and went all the way up front again...

Uh, no. Not worth it.

So we went to IHOP instead and had omelets (which are surprisingly large for a surprisingly small number of calories). It was a fun date. We came home, got back in bed for a couple hours until the kids got up, and then did our shopping online instead.

I love the internets.

Well That Was...Fun

2010-11-25T10:54:00.006-06:00

We're back from the race and I've had a hot shower.

As mentioned before, it got cold. Very cold. When we left the house this morning it had dropped from 64* to 47* in about 45 minutes. Now that we're home it's currently 36*. The wind is still blowing, but only 10-15 mph instead of 20 mph, but the wind chill is 29*. There were sprinkles of rain throughout the race.

But really the weather conditions weren't the tough part. For the first mile and a half I felt pretty good. We were cruising at a little faster than 10 minute pace, and we warmed up once we were running. But then this damn cold I've been fighting kicked in and my chest started tightening up. By about mile 2, it was clear I needed to walk. I waved my wife on and walked for a ways.

My wife finished close to 31 minutes which is the fastest she's ever run a 5k, especially considering the course was 3.18 miles, rather 3.1 (Awesome job sweetie!). She did amazingly well. I finished about 2 minutes behind her, and several minutes over my fastest 5k to date (about 28 minutes).

I'm trying hard to help my wife celebrate her success, but the truth is I'm devastated, and embarrassed. Not only did I not perform very well, I didn't even run the whole course. I'm so frustrated this cold had to hit when it did. It kept me out of the gym for 5 days, kept me up at nights, and dragged me down at the race. I've been preparing for this morning for 6 months, and the only time I've been sick in those 6 months is the week of the race. I'm just really, really disappointed. I should be happy for just finishing at all given where I started, but I'm not. It puts a lot of pressure on me for the next race, because now I have no excuse not to improve my time...

It also made me realize that though I've come so far, I still have a long, long road to go--29 lbs. 29 lbs is a LOT of weight. It's more than my wife wanted to lose TOTAL. It's what I have LEFT, after 6 months of hard work. Why oh why did I ever let myself get this way?!

Embarrassing.

Thanksgiving (aka Race Morning)

2010-11-25T07:30:00.002-06:00

47*F and dropping. 20 mph winds gusting to 35 mph.

This?

Is going to be interesting.

Happy Thanksgiving!

Unforgiven

2010-11-23T20:07:00.005-06:00

The summer I turned 18 I applied to be Summer Staff at our church camp. It was pretty much my dream job at the time. Since the summer between 4th and 5th grade when my mother drove me the 450 miles from my hometown to our conference church camp, dropped me at the curb and left me without knowing anyone, I had been back every single summer. Often I would be at camp as many as 4 or 5 weeks of the summer between music camp, district camp, work crew, Sonshine camp, and others. It was essentially my second home.

Summer staff were coveted paid positions hired by the conference to serve in leadership positions, as well as working to take care of the day to day activities required to successfully put on camps for the hundreds of kids per week the camp hosted. I figured I was a shoo-in, having spent so much time there, and having earned a reputation of hard work and strong work ethic the weeks that I was on work crew (a week of volunteer work each summer). My competition for the one of the summer staff positions was close to home--my cousin Rachel.

Rachel and I had had a rocky relationship at best. When I was in 6th grade her father had been out of work for a couple of years, and she and her mother moved in with us while he stayed in their home town and continued to job search. Rachel's mother, my aunt, had an entirely different style of parenting and was significantly more permissive than my parents. Right or wrong, regardless, it was a disparity that often raised it's ugly head. She was allowed to do things that I wasn't, and I was forced to do things she wasn't, and I was often in trouble for things that she did too, but wasn't disciplined for.

It all came to a head for me when she was diagnosed with bone cancer. Now I know that cancer is a very scary thing. I know that a diagnosis of any cancer must feel horrible (although having a cancerous mole excised from my shoulder didn't really bother me, but I digress). I saw what she went through. I was there for the chemo, and the surgeries, and the year on crutches, and the having to wear a wig. I heard it, tasted it, damn near felt it all myself.

And I also watched her take her experience and use to her every advantage. I saw her con her way into grades without the work. I watched her use her diagnosis to have her mother wait on her hand and foot. I saw her milk it for elaborate trips and lavish gifts her parents couldn't afford. And I saw the sense of entitlement growing faster than any tumor could.

I also saw her use her story as hook to get her into a position on Summer Staff.

And I did not get hired.

I was pretty upset, but I placated myself by moving in with a Christian musician who traveled the state (including to most weeks of the summer at the camp) doing worship music and concerts. I had a great summer despite missing out on Summer Staff.

One such concert trip I met a girl at a church that sparked my interest. We hung out as much as we could that weekend, and we wrote letters back and forth. And wouldn't you know it, her church was on work crew the last week of the summer at the camp. My roommate and I did the music for the camp that week, and when the camp was over he headed home. I stayed behind to spend a few more days with my crush, and I was to ride home with Rachel as it was the end of the summer. It was two birds with one stone--I bought a few days with a girl, and Rachel didn't have to drive 450 miles on her own.

I saw Rachel several times through the week, and she never mentioned when she'd be leaving. Come Friday afternoon, I was out with the work crew splitting firewood (working hard mind you, not out screwing around) when I got word that Rachel was looking for me. I headed back to the dormitory where staff stayed to find out what she needed.

She was in her car, with the engine running.

"I am about to leave you," she spat at me. "Get your stuff, and you better run."

So I zip up the stairs, throw all my clothes into my backpack, roll up my sleeping bag, and head back down stairs. When I get to her car, I try open the back door to put my things in the back seat, but the door was locked.

And then she drove off.

I kept expecting her to come back after a few minutes, but she never did. Instead she left me stranded 450 miles from home with no money, no transportation, not even a cell phone. The first stop possible, she calls my parents and feeds them a bullshit story of what happened. And my parents, in fine tradition, bought every word of it and found me guilty before even talking to me.

My parents eventually bought me a Greyhound bus ticket and I made it home several days later.

But the injustice of that moment damaged my relationship with my parents for years. Even to this day I think it affects the way we interact with each other.

And Rachel?

No, I've not forgiven her. I rarely speak to her. Despite numerous olive branches she's tried to extend, I can't find it in my heart to do so. She doesn't understand why I'm so upset, because she is simply incapable of putting herself in someone else's shoes (in general, not just in this situation). I find her to be one of the most self centered people I have ever met. To this day she still believes she was fully in the right.

This came to mind yesterday as I was cruising around Facebook. She's one of my "friends" on there, and I forget she is. When I post exciting things, or funny things the kids have done or said, or pictures of our new dog, she often comments. It feels a little intrusive because they are personal things that I don't necessarily think I would normally share with her. I'm contemplating unfriending or blocking her, but I don't want to create an issue between my parents and her mom.

Do you have any grudges you haven't been able to let go?

This? Is Not Good

2010-11-22T14:45:00.004-06:00

My inaugural 5k race is coming up on Thursday.

I haven't been to the gym in 3 days and the way I feel makes tomorrow seem iffy also. I've come down with a cold that has settled comfortably in my chest. I'll spare you the gruesome details, but if my patients coughed up some of the funk I've hacked up recently, I'd be grabbing for a sterile specimen cup.

Lucky for us it's forecast to be 47* and rainy for the race.

In other news I've started my Capstone hours. I've been assigned to work nights on the Transplant ICU at Gargantuan Hospital. My preceptor rocks, so that takes away the sting of not getting to spend the time on my home unit.

Oh and today my wife and I are preparing Thanksgiving dinner for 53 people at a low income housing apartment complex.

Welp, back to the kitchen.

MyFitnessPal & RunKeeper

2010-11-18T12:46:00.001-06:00

I've had my HTC Aria for about 6 months now, and I absolutely love it. Yes, it's a Droid, and no, it's definitely NOT an iPhone. I'm just now starting to sift through the mounds of apps and I've found a couple worth sharing.

First, MyFitnessPal. This is an amazing app, especially considering it's FREE! This keeps track of your calories, your exercise, your weigh-ins, even how many glasses of water you've had. But more than that, it has a searchable database of almost 500,000 foods including brand name and generic items, and when you add them to your meals, it adds nutritional info too. Calories, fat, carbs, protein, vitamins & minerals, and cholesterol. You have to check this out, it's very cool. Pretty sure they have a website too if you don't have a smartphone.

Next up is RunKeeper. This app does exactly what it sounds like--keeps track of your runs. It plots your course on GoogleMaps, keeps distance, speed, pace, calories, etc. Again, very cool, and FREE. There is website support too, where you can browse routes others have run. There is also a virtual race challenge where you can challenge someone near your level to a race and RunKeeper logs the runs and declares a winner.

Check them out, they've both helped me tremendously.

And I'm down to 237.0 today after running 47 min at an 11 minute pace. Hoping to be 225 by graduation, 4 weeks away.

Then What? (Thoughts From the Treadmill, Part III)

2010-11-17T08:29:00.000-06:00

Today as I cruised along on the treadmill, I started thinking...

What will my next degree be in? After CRNA school I mean.

I came down to just a couple of possibilities, either meteorology (so I can go storm chase) or enology & viticulture (so I can make wine). Maybe both at some point.

That will be my 6th (and possibly 7th) degree(s).

Of course a degree in literature might be nice one day...

BS in Biology, May 2001
BS in Human Anatomy, December 2007
Doctorate of Chiropractic, December 2007
BS in Nursing, December 2010
Doctorate of Nursing Practice & CRNA, December 2014?

Then what?

(That shrieking sound, by the way, is my wife cursing under her breath...)

So...

2010-11-16T14:18:00.002-06:00

I can't talk about it yet because it isn't officially official, but I got a phone call about 20 min ago that made me literally jump up and down, giggling like a little girl.

And So I Wait.

2010-11-15T22:39:00.004-06:00

And I pray.

A lot.

The interview went really well. But then so did my interview with Level II.

Gargantuan Hospital seems much more focused on excellence though. Several times throughout the interview it was reiterated to me how challenging this particular unit would be. They explained that the level of knowledge required of me by the critical care internship as a whole (meaning the mutual classes with the interns from the other ICUs as well) would not be sufficient for the CVICU. I would be held to a much higher standard. I was told that it would be starkly obvious if I did not study, and that I would be sent home if not prepared.

I said, "Bring it on."

With what I hope was a charmingly crooked smile and a gleam in my eye.

Their warnings only served to whet my appetite. I want it now more than ever.

As soon as I got home I wrote out a thank you card and popped it in the mail. It's the first time I've felt compelled to do so.

They gave me no time frame of when they'll be making a decision.

And so I wait.

And I pray.

A lot.

The Night Before

2010-11-15T00:25:00.000-06:00

My interview is bright and early in the morning. I'll be up to get ready well before the sun comes up, even with the recent time change.

I'm nervous and anxious.

Mostly I'm just contemplative. It's been such a long and tortuous journey to get here. And now I stand at the foot of the mountain of my goal. This position I'm interviewing for really is my dream job. It's the.position I would have turned down any other offer to take.

Part of me wonders if that's not the reason I've had the disappointments and frustrations up until this point.

I really don't know what I'm going to do if I don't get this job. It's unthinkable at this point. I must really keep my mind on the positive and the potential.

I should try to sleep now.

Most of you won't read this until I'm already in with the lions. Please send me a prayer or a good thought. It would mean a great deal to me.

BMI

2010-11-14T08:22:00.000-06:00

After reading Chris's post over at The Man Nurse Diaries regarding his efforts to get fit and lose weight, he discussed BMI. Of course how truly useful the BMI measurement is remains to be debated by people smarter than me. But regardless of how valid the number is in actually delineating health, it can be used to track progress. And it's a measurement I'd forgotten about (when you're as densely framed as I am, it really holds little or no validity, but I digress) until Chris brought it up.

I googled a BMI calculator, and then plugged in my numbers.

At 6'1" and 284 lbs (my heaviest), my calculated BMI was 37.5.

At 6'1" and 241 lbs (my current), my calculated BMI is 31.8.

At 6'1" and 208 lbs (my goal weight), my calculated BMI will be 27.4.

To put myself at the high end of normal BMI of 24.9 or lower, I would have to weigh 188. I just don't see that happening. Not without a tapeworm or some other disease...

Wedding Re-Banding

2010-11-13T16:12:00.004-06:00

Much like my pants (as mentioned in last post), my wedding band is loose on my finger due to my weight loss. I've mentioned that it's slipped off in the shower before. Lately I feel like I have to take it off when I'm on the treadmill because my fingers get so sweaty I have visions of it coming off, getting into the innerworkings of the treadmill, and simultaneously getting destroyed while launching me halfway across the gym in a freak treadmill accident. The final straw was this morning when I realized the a simple shake of my hand allows my ring to slip off unassisted. It's time to get a new, smaller ring.

My wedding band is titanium and I love it. It is so unbelievable light, I soon forgot I had it on after I started wearing it. This is huge for me, because I'm not really a jewelry kind of guy, and having something on my fingers or hands has bothered me in the past. These days though I find myself checking to make sure it is indeed on my finger, and I take comfort in its presence and what it represents to me. The finish on my ring has worn to a nice satin finish from all the minor scratches and scuffs. One my suspect that titanium would be so hard it wouldn't scratch, but that just isn't the case. It is also slightly out of round after a run-in with an airbag during a wreck during my junior I semester. It holds tremendous sentimental value to me, and I will likely continue to wear it on a chain around my neck.

This time out, I think I am going to get a tungsten carbide ring instead. The shops that I've been surveying have lifetime warranties on scratches and damage--tungsten carbide is just that strong. Additionally, most places offer a lifetime sizing warranty--if you lose or gain weight, they'll replace your ring with one of a proper size since tungsten carbide can't be resized. Impressive, yes. But likely this just means I'm going to waaaaay over pay for my ring if they can afford to do that. But whatever.

I thought I'd post pictures of the leading contenders, and see what you guys think. Feel free to leave your opinion in comment form, but realize my wife kind of has final say on this one. :)

First up is the Guiness Celtic Knot ring. Given my Scottish background, I dig the Celtic themes as you will soon see. I like the contrast this ring has between the knot and the background. I also dig the satin like finish of the background. I like the beveled edges, and the flat profile. I should add this is my wife's favorite at the moment.

I like the subtle nature of this design. It's Celtic, but slightly modern. There isn't a lot of contrast with this one, which I also think is cool. It's the cheapest of the three by a long shot, not that that is the most important thing, but it is a bonus.

I think this is my favorite of the three. I dig the black tungsten. A lot. Again with the Celtic theme, and it doesn't get much higher contrast than this one.

Anyway, let me know which is your favorite and why, if you please.

Oh, and 241.2 after my workout this morning.

Hodge Podge

2010-11-12T08:15:00.000-06:00

I'm continuing to lose weight despite being a little loose with my calories lately. In fact I flared back up to almost 246 after having a low of 242.8 recently. However as of today I was back down to 242.0, so a new low benchmark set. I've done decently with calories today. The good news of yesterday afternoon made it that much easier. A big part of my extra calorie excursions were of the liquid form--as in alcohol--as a result of my being passed over for the Level II hospital's critical care internship. I feel like I'm back on track though.

On a related note, today I wore a pair of jeans I had been clinging to before losing weight, even though they were really too small and too tight. In leaving the house for errands I managed to get out without a belt on, and it turns out that was a big mistake. I could barely keep them on my body. When I got home I attempted it, and the pants slid off easily without unbuttoning them. So, it appears my skinny jeans are now to big to be my fat jeans even...

On another semi-related note, part of my calorie-cheating came whilst having friends over to the house for dinner. We've known this couple for several years but haven't really done any one on one time with them. We had an awesome time--in fact my wife and I both were going to bring up to the other how much fun we had. They have three great kids that match up in age to our two youngest, and they had a blast running around the house like a squadron of fighter/bombers making all kinds of noise. It was a truly comfortable evening. I made a pizza from scratch, using my breadmaker to put the dough together, and then topping it in a mostly margherita style. I laid down some Muir Glen Organic pasta sauce and covered that with a few cups of finely chopped spinach. Then came a layer of grated mozzarella cheese overlaid with thinly sliced tomato rounds. I topped it all off with chopped fresh basil, and finished with a flourish of cubed fresh mozzarella round from the gourmet cheese counter. I wish I'd taken pictures because it was not only extremely delicious, it was also pretty!

My wife and I registered for our local Turkey Trot for our debut 5K. I'm pretty nervous because I've only run on the treadmill, I haven't run outside. Until today that is. We went to a local park with a jogging trail and did a lap. It was only 1.09 miles, but I really want to take it slowly because I don't want to risk getting hurt because of the new surface. It was then that I realized running isn't about the races anymore. It's my avenue to getting fit and losing weight, and if that means treadmill only, I'm so there. I just don't want to risk an injury that's going to set me back. We'll see how I feel in the morning.

My last final exam and a big scary OSCE are today. After that I'll only have my 96 hour Capstone left before I'm awarded my BSN. Did I study at all last night. Not a lick. I so don't care. I'll probably end up with a B in my gero class, but I simply don't care. It's only a 2 hour class and I think I wrapped up all A's in the other 12 hours I'm taking. We finally got our Capstone assignments--several weeks after others in my class. I got assigned to the Transplant ICU at Gargantuan hospital. I'm a little frustrated with that assignment because my very first choice was the CVICU where I'll be interviewing soon. And two of my clinical-mates are IN the CVICU. Grrr.

That's probably enough randomness for now.

Oh. My. Goodness.

2010-11-11T13:03:00.002-06:00

Gargantuan Hospital CVICU just called me to ask if I was still interested in interviewing for a position.

Somehow, "Yes. Yes I am," didn't seem to cover it appropriately...

However, "Oh holy hell yes!" didn't seem like quite the right impression to make.

Yaaaay!

Gettin' Busy

2010-11-11T12:01:00.003-06:00

So this post will probably be utterly mortifying for my wife, and the few people that read this that know me in person. I can hear her mortal cry now, "Not again!"

It's true, I have been known to open my mouth and say a little too much from time to time. Ok, maybe a little more often than that...like daily. But onward we plunge. If you embarrass easily, I suggest you avert your eyes now--if you can tear them from the impending train wreck, that is.

I'm a pretty insightful person, especially for a guy I think. Although it isn't always considered a particularly male trait, I have a pretty highly developed sense of empathy. And frankly this ability to shift my senses to another person's point of view or frame of mind makes me a better lover. Combine that with my affinity for reading non-verbal cues, and I think I'm rather uniquely equipped to, say, sense a rising crescendo of feelings and sensations as they approach a particular event and resolution. I think my wife is (routinely) a happy woman as a result. So that aspect hasn't ever been a problem.

As tough as it is to admit, it's only fair that I reveal the flip side of that coin--my lasting power (or lack thereof), a distinctly male trait it would seem. The downside of having a creative, experiential mind is the tremendous onset of sensory input when engaging in, well, stimulating activities. I lack the control to manage the onslaught of imagery and sensation, and end up losing myself far sooner than I want.

Well, combine a low dose of Lexapro and a 40 lb weight loss, and I have gone from Speedy Gonzalez to Marathon Man. Ok maybe not Marathon Man, but 10K Man anyway. There seems to be a, erm, size difference as well.

I am absolutely loving what sticking with running has done for me. I feel like I'm gaining my life back, pound by pound.

F-off, but Sincerely and Cheerily

2010-11-10T14:32:00.003-06:00

Dear nurseXY,

Thank you for your interest in Level II Hospital and your recent interview for the position: CRITICAL CARE RESIDENCY JANUARY 2011 (Job ID 27400 ).

At this time we have decided to pursue another candidate for this position. We encourage you to review other open positions of interest at www.levelIIhospital.org/jobs.

After registering for an account, you can build a job agent that will notify you via email when new positions are available that match your profile.

We wish you the best of success in your career search.

Thank you,

Super Cheery HR Rep

Frustration

2010-11-09T18:22:00.005-06:00

Well it appears that Level II hospital has declined to offer me one of the coveted critical care residency positions. Several of my classmates have gotten those happy phone calls however-- 4 that I know of.

The first one I heard about is a girl that routinely came to class still drunk from the night before. Several times she's fallen asleep during lecture and started snoring. Since she sat behind me I often was the one to wake her. She has failed several exams that I know of, requiring being put on academic contract.

Next offer I heard about was to the girl who has decent grades, but also has a criminal background. It seems she got drunk one night, drove (drunk) to her baby daddy's apartment (a one night stand) and physically assaulted his girlfriend. Apparently there was a pair of scissors involved.

The next offer went to the girl with 4 kids and a husband that hits the club every weekend looking for action, sans husband. She also couldn't be bothered to show up to class or clinical on time, if she showed at all. Rumor has it she has far less than a 3.0 GPA, which was supposedly a requirement for the job.

The last offer I heard about went to a woman who asks questions that are so ridiculously basic the instructors would often misunderstand what she was actually asking. I suffered through 3 separate clinicals with this woman and was routinely amazed at what she didn't know. She failed her exit HESI so badly that the remediation classes were too advanced and she had to be individually instructed.

Now I know this is going to come across so terribly arrogant, but for heavens sake, I don't understand why they got hired and I didn't. I just feel like I was a much, much stronger candidate. I am literally aghast at who got hired. So are several of my friends and study partners-- any one of whom I'd be just fine getting passed over for.

Frustrated doesn't even approach my frame of mind.

This is one of my lowest points in nursing school to date.

Trying not to panic.

Did you know even the military wants at least a year of experience?

Haunted

2010-11-06T21:48:00.004-05:00

I have always felt a deep connection to the land and elements of the outdoors. I suppose it comes in part from the way I was raised. I grew up on a working alfalfa farm in the highlands of the great American Southwest. As a farmboy I learned to be in tune with the weather, the earth, and all living things. Maybe that sounds a tad on the New Age side, but it really was a product of my way of life in those early formative years.

At times though, I think it's deeper than a learned behavior. When I recently returned to the beaches of California where I was born, I was taken aback by the deep seated feeling of belonging that washed over me, like the beautiful waves of the mighty Pacific rolling up on the beach. I wasn't prepared for the strength of that feeling, especially considering I really have no connection to the area anymore. We moved when I was 5 years old, and I have always considered the state where I grew up to be my "home".

Living in this vast urban jungle, where my metroplex alone has more than 5 times the population of the entire state where I grew up, I think some of that connection has been dulled and muted. There is one time of year that these feelings surface however. During the tempestous Spring weather of this area, the tortured, angry clouds roiling in the fitful heat of April and May stir my soul to life. My eyes are drawn ever heavenward, and the low rumble of distant thunder beats through my breast like some extra-corporeal heartbeat.

It's for this reason that I'm an avid fan of the Discovery Channel show called Stormchasers. If you've never seen it, it chronicles the exploits of various scientists, videographers, and meteorologists as they chase severe storms during the severe weather season. If you haven't seen it, you should check it out on Wednesday nights.

This last week's episode was an amazing display of tenacity and planning, and an exercise in adrenaline-pumping, heart-fibrillating intense action as one crew positioned themselves for a direct hit by a large and strong tornado. They were in a purpose-built protective vehicle fitted with IMAX capable cameras, and it was an amazing spectacle. It was the culmination of years of hard work and several hundred thousand dollars investment. This pinnacle of success rested largely on the shoulders of one of my favorite cast members of the show, meteorologist Matt Hughes. It literally brought tears to my eyes in respect for his amazing achievement. The comraderie and the sense of brotherhood swelled from the TV screen and surrounded my soul, buoying me upwards. I was better for having lived it through their experiences.

It was a beautiful episode.

And it utterly destroyed me.

You see, the show was dedicated to Matt Hughes. Posthumously.

It was only a few short days after the filming of the footage for this episode that Matt Hughes injured himself in a suicide attempt. About a week later his injuries proved fatal, and he passed away. He leaves behind two young sons and a wife.

Matt battled valiantly against depression, and in the end his tortured demons stole away his will to live.

This strikes so deeply a chord within me as now I've finally given name to the winged fiends that torment my heart and mind; and their names are depression, self-doubt, and shame. I know the battle that raged within Matt, and it steals the breath from my chest to learn of the loss of a brother in arms. I've never met the man, and yet it just plain hurts.

So Matt, may the wings of the storm winds bear you up and carry you to place of peace. Know that though your will to live was struck down, you have not been conquered. Your grace and laughter lives ever on in the memories you've left behind. You've created a legacy borne of love and eternity that never will die; even as the sound of your name rings on in the silence.

As to the demons that so tortured you, I think Milton says it best, "So spake the Cherub; and his grave rebuke, Severe in youthful beauty, added grace Invincible. Abashed the Devil stood, And felt how awful goodness is, and saw Virtue in her shape how lovely—saw, and pined His loss."

Be free my brother.

Livin' on a Prayer...

2010-11-05T10:37:00.002-05:00

...and a whole lot of faith.

I sent this email to my boss at my current unit this morning:

Thank you for considering my application and offering me a position. After much prayerful consideration, I am respectfully declining the offer, and am choosing to pursue other opportunities for employment.

Regards,

NurseXY

No, I haven't secured another position.

Yes, I'm more than a little freaked out.

No, my wife won't kick me out of the house and has agreed to continue being my Sugah Mama should I not get a job.

Yes, I covet your prayers and good thoughts.

I'm Melting, I'm Melting...

2010-11-04T21:41:00.003-05:00

Ok, I don't have any flying monkeys as lackeys, and I do get wet on a regular basis (I shower at least once week), but I do feel a bit like I'm melting.

On the treadmill tonight I suddenly realized I was feeling the hem of my shorts brushing my calves, which was an odd sensation--one I hadn't felt before. It was then I realized I was literally running out of my shorts. My athletic shorts were falling off of me. I yanked them back up, but it was just a couple of minutes later that they were sliding again. I had to cinch the drawstring down to keep them on!

Then in the shower after my workout, my wedding ring slipped off my finger and fell to the floor of the shower. Lucky for me, it didn't roll down the drain, because that would've really sucked. Not to mention tough to explain to my wife...

Workout was a good one, 30 min on the hill climb function at a 10 min pace, then I pushed myself an extra two minutes. 706 calories.

Oh yeah, 242.8 lbs.

Something Wicked This Way Comes

2010-11-03T20:25:00.004-05:00

So I did it. I registered for the NCLEX. $200 for the test, $139 for the background check, and of course whatever the fingerprinting place chooses to charge me. Nevermind this is like the 4th background check in the past 3 years. With the same company. And of course I have to pay every time even though they need only pull up my file and hit "Print" or "Submit" or "He's a Good Dude", whatever their button says. I wish I could just take the NCLEX now and get it over with. My hope is that my ATT comes in time for me to take the test before we leave for our cruise. But of course I'm at the mercy of the BON. My CON FedExs their part of the paperwork at 8 am the day after graduation, which is nice. No extra charge you know. I guess that's covered by the $20K of tuition and fees...

The one section of the "Candidate Bulletin" that made me a little nervous follows:

NCSBN may cancel or withhold a candidate’s results if, in NCSBN’s judgment, there is a good faith basis to question the validity of the results for any reason, notwithstanding the absence of any evidence of a candidate’s personal involvement in irregular activities. Evidence of invalid results may include, but are not limited to unusual answer patterns or unusual score increases from one exam to another. If a candidate’s result is cancelled, revoked or invalidated without a finding that the candidate engaged in irregular behavior, the candidate may appeal the decision and/or will be offered a free retest. An appeal is the candidate’s exclusive means of redress with regard to NCSBN’s decision to take this action.

Basically, if I read it correctly, they can cancel your score for any reason that they want to. This is reminiscent of my experience taking the ASVAB several years ago. I scored a perfect score, and the recruiter assumed I cheated. I was made to take a paper version of the exam with a monitor sitting in the room with me to ensure I couldn't cheat. I scored another perfect score just to spite them.

Bastards.

The Big "V"

2010-11-02T19:02:00.002-05:00

So Nikkolish over at a crazy beautiful mess (which is a great read btw, check her out!) mentioned in passing in a post that her husband would soon be going under the knife for some, well, plumbing changes.

Like many women, Nikkolish (and one of her commenters) is wondering what the big deal is? And why we men get worked up over this "little procedure". As a man who has experienced this modern day rite of passage myself, I thought I'd articulate what other men may have trouble expressing.

First off I'd like to acknowledge that there are a whole lot of reasons why a vasectomy makes a lot of sense. For one, it's an outpatient procedure, many times done right in the office of your favorite urologist. It's minimally invasive as procedures go, the incisions are tiny, and the whole thing takes like 30 minutes if your doc doesn't hurry (and I would recommend finding one that doesn't!) The comparable procedure for females is much more complicated and involves anesthesia which has its own inherent risks.

It means your wife can stop taking oral contraceptives, which again hold their own inherent risks, not to mention the hormonal roller coaster every month.

And it means never having to mess with another condom, which are a pain in the crotch, often quite literally. I mean I never learned how to take one of those off without somehow pinching the tar out of myself and donating the top layer of skin at the same time. Or worse yet, if your wife has a latex allergy (like mine), your choices are to wrap yourself in the skin of some dead animal, which is sooooper sexy let me tell you. Or the new and improved poly vinyl condoms, which do NOT stretch at all, and slowly choke your inner warrior into submission by way of the nuclear sleeper hold.

Suffice it to say, there are many reasons to get a vasectomy. Some of them good even.

So why do guys have such an issue with this "little procedure"?

Let's start with the obvious. From since before we can remember, us guys have been conditioned. In fact, I'm pretty sure it was while we were still baking in our mothers' lovely wombs that we were handed our own special twig and berries, along with our man card. There was no owner's manual (hence our disdain for instructive manuals and maps of any kind for the rest of our lives,) and the instructions were very, very simple. Protect these suckers at all costs!

At. all. costs.

This indoctrination continues throughout our lives. Get smacked in the nose? No matter, blood is way cool. Get blasted upside the head? No problem, chicks dig black eyes. But get kicked in the nads? Not only does it hurt like a $(@#&, but you're quite likely to get laughed at as well. Because let's face it, nothing is funnier to other men than some idiot who was dumb enuough to break the most basic rule of life--Protect these suckers at all costs!

At. all. costs.

And now you know why TV shows like Jackass and America's Funniest Home Videos have been so successful.

So maybe you can understand our hesitancy to willingly let some dude purposely cut a hole in our junk. It goes against 20-30-40 years of social conditioning. Conditioning that has been the meaning of male life for centuries upon centuries.

Not to mention we might get laughed at.

But I know what you're going to say, "That's what they make benzodiazepines for!", right?

Ok, hold on to your ovaries, because we're about to talk about the emotions of the male species.

Sure, we males are human too. And that means we contribute to the human race in a variety of ways. We reap respect from our jobs. We strive to uphold the responsibility of teaching our sons how to be men, and teaching our daughters what to look for in a man when they decide to get married. We participate in church, family time, and marriage relationships. We men have great purpose in this world, and I will go toe to toe with anyone (man, woman, or otherwise) that tries to belittle our existence. But call it an evolutionary throw back, on some gut level when we get a vasectomy, we lose a very basic mammalian and biologic function. We lose our ability to sow our oats, so to speak. It's long been debated whether the male simply exists to impregnate females, and regardless of your position on the topic, there is a loss of function that affects the male psyche in a deeply personal way.

To take it step further--I would wager that the times my wife has loved me the most deeply has been when she's found out that we were pregnant. Those moments were deeply satisfying for me as well. The list of inequities and shortcomings that a female will overlook in a man is long and distiguished if that man is the father of her unborn children. When a man loses the ability to grant that most basic desire of a woman, it can be a frightening thing. In fact, the male mind might wonder if he might be up for replacement if he no longer can function in that role. At that point, what seperates him from the other 4 billion males on the planet?

Maybe you don't understand everything I've written here. Maybe you don't agree with everything I've written here. That's ok. It's just one man's musing about losing his sperm count.

Now quit giggling!!

Beast of Burden

2010-10-31T17:40:00.000-05:00

My kids were invited to a birthday party yesterday. It was for the son of one of my wife's friends from work, but my wife worked the night before and the night of, so the responsibility of taking the kids fell to me. It was at the zoo which is a great idea for a little boy's party, except...

You may have heard it's Halloween this weekend. Our local zoo is really awesome, it's one of the best in the country I think. Better even than the famed San Diego zoo. Every Halloween they put on a Boo at the Zoo event for the kids, and I would imagine that most zoos in the country do something similar. But given the popularity of this particular zoo, it's a major, major event. And that translates into a nightmare of traffic and parking. The zoo is set back from the main road about 2 miles, and all along the drive leading up to the main zoo parking lot are open grassy fields and park areas with playgrounds and whatnot, each with its own parking lot. To give you an idea of how much traffic there was, it took us 40 minutes to travel from the main road to the current active parking area. And on top of that, they were parking people on the grassy fields, because all of the lots were full already. This left us over a mile from the entrance of the zoo.

Walking in was ok, I stashed the youngest in his umbrella stroller and everyone was so excited it was an easy walk. Lucky for us we already had our tickets, because the line to buy tickets had to have been several hundred people deep--at each ticket booth. Once we got in, it was a nightmare tangle of people everywhere. Add to the mix the free candy the zoo was handing out for the event, and the kids were so hopped up on sugar that the entire event was destined to reach critical mass.

We arrived a little before the party started, and when all the kids from the party headed over to the candy scoring portion of the event, we chose to go see animals instead. We saw parrots, and lions, and tigers, and bears, and oh my...

After the party of course the return trip to car was a different story. Little kid feet were not happy and excited anymore, and over a mile is a long way for little legs. I ended up with my 4 year old on my shoulders. The walk in had been effortless for me thanks to my new found fitness, but the added weight of my daughter on my shoulders really kind of tired me out by the time we made it back to the Jeep. And then it hit me, at my new lowest weight of 245 lbs, I am 39 lbs down from my heaviest. My daughter weighs a few more pounds than that, but just. With her on my shoulders, I was very near the weight I used to be, and my knees were hurting me, and my hips were aching. I was winded, and sweaty.

It was a very literal demonstration of exactly how far I've come, even without realizing exactly all the benefits I've reaped to date. I have 33 lbs to go to hit my goal weight. I'm not sure if I'll make it that low or not because it seems my weight loss has started to slow a bit. We'll see.

Honor Roll

2010-10-29T10:06:00.001-05:00

I received a notice in the mail a couple days ago that I'd been named to the honor roll for last semester. I'm appreciative of the honor, but I'm a little bewildered. I didn't do any better or worse last semester than previous semesters, but it's the first time I've been named to the honor roll.

*shrugs*

Who knows.

Interviewed

2010-10-28T22:12:00.000-05:00

I interviewed for the critical care residency at Level II hospital today. Let me tell you, this interview was no joke--they were not messing around. There were 5 of them, and if you're keeping score there's only 1 of me. The educator in charge of the residency conducted the interview, and the other 4 in attendance were managers from various ICUs.

Honestly though, I just took a deep breath and forced myself to relax. They were all very courteous and friendly, for which I was thankful. I at least felt like I was charming them a bit.

And then the questions started. First up were the expected questions, "Why our hospital?" And "Why critical care?" Then she cut to the situational questions. Fifteen of them. Fifteen! There was only one that I stumbled a bit on--I asked that we skip it and when we came back to it, I had a ready answer.

The program sounds pretty sweet--it's two years long. The first 3 weeks are hospital and nursing orientation. Then comes 4 weeks on each of the 5 ICUs. Then it's match day, and the home unit starts the full on orientation for at least 12 weeks. Then the remainder of the 2 years is spent working and still some class time. The residency closes out with a CCRN class and the CCRN exam. In return, the hospital wants a 3 year commitment starting with the residency.

I feel pretty good about the interview, but they are interviewing through the end of next week. So we'll see.

***********

I got to run with my wife today for the first time in several months. It was a good workout. 30 min at a 10 min pace, but on the hill climb function on the treadmill. I only had it set on level 1, but it was good for 674 calories. Weighed in after my workout at 245.0.

Level II, Part Deaux

2010-10-27T09:27:00.002-05:00

I have a panel interview with Level II hospital tomorrow morning at 11 am. This is for their critical care residency. It sounds like a good program. We'll rotate through the 5 different ICUs over 6 months, and then we'll have a match day to pick a home unit.

As usual I'm a bundle of nerves.

On Hope

2010-10-26T08:44:00.004-05:00

Thank you for all of the encouraging comments on my last post. They were much appreciated. Your comments got me thinking about quitting, failure, and other such things, and I asked myself a question.

What is the opposite of quitting?

The obvious answer is, well, not quitting. Finishing what's started. Perseverance.

If we say pressing on is the opposite of giving up, then the antidote to quitting and the fuel for perseverance is hope.

Hope is a beautiful thing. Hope doesn't require completion. It doesn't matter how long, or how hard we strive to attain a goal, as long as we have even the faintest glint of hope, we will never quit. We pause. We may rest, or re-group. But we rise again to reach for the goal.

People say it's not whether you win or lose, it's how you play the game. There is great wisdom in that short proverb, but I want to take it a step further. Without hope, we'd never step on the field to play the game in the first place.

And so I urge you, guard your hope closely. Clutch it tightly to your chest, shielding it from life's tempest like a candle in a storm. Feed the flame eagerly, nurture it into a raging inferno that consumes you from within. For from the ashes of our self-doubt and self-imposed limitations our dreams will rise, realized.

I hope for you. Whatever your dream, I hope for you.

On Quitting

2010-10-24T23:21:00.000-05:00

I quit.

No, really, I quit on a regular basis. It's not usually at anything earth-shattering, but it happens. I've noticed it most recently at the gym. The treadmill is a very objective way to measure performance, so when I set a benchmark it's all to easy to see my progress, or lack thereof.

I don't understand what the difference is from day to day. For example, I've run 30 minutes at a 10 minute pace numerous times. In fact I recently ran 40 minutes at that pace. Yet, some days I end up pulling up and walking less than 15 minutes in. I don't sense that I'm hurting any more than the days that I'm more successful--I just seem to have less tolerance. Sometimes something else going on in life is bothering me so badly that I simply can't cope with the discomfort of working out.

It's very frustrating to me. I'm aware that this reveals a great deal about my character, about my mental toughness. Or rather, my mental weakness.

This pattern of quitting carries over into all aspects of my life.

Did I quit too soon when life got uncomfortable after I graduated chiropractic school? Did I give up too easily? Did a little adversity cause me to fold and abandon the profession altogether?

Why was I so quick to post about being done with my marriage? Why did I want to quit after being with my wife since 1999? Is 11 years of commitment so easy to discard?

When one of my better friends from my small group at church tries to challenge me and my faith, why do I simply consider ending the friendship? Sure he isn't particularly good at being diplomatic, and has a certain talent for getting under my skin, but he, his wife, and kids are also among my wife's, my kid's, and my better friends. Why would I simply choose to remove them from our lives?

Because I quit.

It's an embarrassing habit to admit.

This weekend at work I helped take care of a gentleman that wasn't particularly old (middle 50s). He was a relatively newly diagnosed diabetic, and he was having a hard time complying with his regimen of care. He was on our unit for a round of DKA--he came in through the ER with a sugar in the 1200s. His wife was attentive and present. And she was trying her damnedest to get him to change his ways.

We got his sugar down, but he was terribly brittle. His hourly checks were jumping all over the place, sometimes 300-400 points in an hour despite being on an continuous insulin drip. But his level of consciousness was improving and his wife was able to talk with him. Even then she remarked at how depressed he was, and we reassured her that it was just the severe blood sugar extremes his body had been dealing with.

We began having a little trouble keeping his sats up. Every time he'd doze off, he'd start de-satting, and we kept having to rouse him, get him to deep breath and cough, and crank his O2 up to keep him above 95%. We paged the pulmonologist to come take a look at the patient, to possibly discuss a planned intubation, rather than having to emergently tube him in a crisis.

When the doc walked in to assess him, the monitor started alarming. Sats were fine, but his HR was dropping. As we watched he dropped from the 60s to the 50s to the 40s. I dashed across the hall to wheel in the crash cart, and by the time I got back he was dropping from the 30s into the 20s. And he just kept dropping. All the way to asystole. Code doses of epi and atropine didn't produce so much as a wiggle in his ECG. CPR perfused him a little, but as soon as we'd let up, he was still flat-lined. After 34 minutes of coding him, his wife asked us to stop. And the doc declared him.

We were all a little shocked, and completely at a loss to explain what had happened to him to his wife. But she knew.

"He just gave up," she said.

"He quit."

-----------

Saturday evening I went to the gym. There was only 1 other person upstairs in the cardio area when I got on the treadmill. I set a slightly slower pace than usual (5.5 mph instead of 6) just to ensure I'd make it to the end of my 30 minutes--something I'd failed to do in my previous 2 workouts. With Winston Churchill echoing in my ears I then proceeded to run for an hour, covering 5.7 miles and expending 1135 calories.

“Never give in, never give in, never; never; never; never - in nothing, great or small, large or petty - never give in except to convictions of honor and good sense."

--Winston Churchill

Ding Dong...

2010-10-22T10:32:00.002-05:00

...the mighty exit HESI is dead.

1375.

I'll take it.

Next, skills check-off in an hour.

And Rancorous the HESI Lurks

2010-10-21T10:25:00.003-05:00

Posts have been a little anemic lately, but for good reason. Tomorrow I take the dreaded HESI. HESI is basically a comprehensive exam over the whole of nursing school. We've been taking sections of the HESI at the end of each course, and I've typically scored in the 1400-1500 range, so I'm relatively confident. However, the comprehensive nature of this final exam (and the length, 160 questions) has me a little nervous. Which is a good thing I think--i've been buried in my HESI review book and doing online practice tests all week. My school is nicer than some as I only have to make an 850 to pass, and I get 3 chances, but I'd really like to just check this box off and move on.

In other news I have my internship interview on my home unit today. I'm sure I will be given a hard deadline for my decision. This leaves me in a tough spot as I don't have a formal offer from anyone else yet. Today is the 2 week mark of when I was supposed to have heard from individual units at Gargantuan Hospital. Also Level II hospital sent out an email stating interviews for the critical care residency will begin next week. And I have heard absolutely nothing from Awesome Children's Hospital at all, after having applied more than 2 weeks ago. They are appearing less and less awesome as time rolls on.

I bought my gown, cap, and honors cord today.

Anyway, that's a little update.

Hello 240s

2010-10-19T00:39:00.000-05:00

248.8

I have now lost 35 lbs from my heaviest of 284.

Taco "I'm In" Hell

2010-10-16T16:41:00.000-05:00

On Sundays after church I often take the kids through the drivethru at Taco Bell. My two youngest love the bean burritos (my younger daughter is a vegetarian, yes, by choice, and yes, from birth and 4 years later still going strong, and yes, we attempt to introduce meat to her every so often, and no, she won't have anything to do with it, and yes she gets plenty of protein, and yes, she's in the 99th percentile for height and taller than her friends and cousins that are 6 months to a year older than her and boys but I digress), and who can argue with the "run for the border" price?

Also relatively new to Taco Bell's menu is the addition of the Fresco style option. Essentially choosing this option 86's the cheese and sour cream, and replaces it with spicy pico de gallo and lettuce. It doesn't super dramatically reduce calories, but it cuts 40-80 calories off any given item. And when you're watching calories like my wife and I are, every 40-80 calories makes a difference.

So this Sunday, we roll through the drivethru. Normally I love our Taco Bell. It's right around the corner from our house, it's brand new, and the staff is very, very fast. They also skip the "Would you like to try our " greeting. I hate that--we're already dumbing down our food to something that can be prepared in 15 seconds flat, do we really need them to think for us in the drivethru lane also!? Anyway, I love that they skip that part and instead say, "Hi, how are you today?"

And I reply, "I am well, how are you today.

Then they reply, "I am good, thank you for asking."

It's such a pleasant interchange. It takes all of 10 seconds, and it just brightens everybody's day. I also make it a habit to consciously be extra polite to people that work food service, retail jobs, or other service oriented jobs. They are people too, although they aren't often treated well. Not to mention I often receive exceptional service as a result. And if I don't, I probably was going to get crappy service anyway, so what's been lost?

Enter today.

Today I tried to order my food Fresco style, and the girl just couldn't get it right. She put in the wrong items to start with. Then when I tried to correct her, she just added what I did want to the list without taking the unwanted items off. And then rather than Fresco style, she just started taking things off my items one by one. Salsa? Gone. Cheese? Out of here. Sour cream? Hasta la vista baby! Onions? Hit the road Jack. It was so infuriating. I've actually had less frustrating conversations with brick walls!

Finally the manager got on the intercom and got everything straightened out.

But the shenanigans continued when I got to the window.

The girl took my credit card, and I was asked if I wanted "Hot, Fire, or Mild sauce."

I said "No."

She asked if I wanted "Hot, Fire, or Mild sauce."

I said, "No thank you."

Then she asked me if I wanted "Hot, Fire, or Mild sauce."

And I didn't bother answering while I helplessly watched her stuff a handful of each into our bag.

Next, the girl told me the total, and held out her hand expectantly waiting to be paid. I told her that I had given her my card already. She couldn't find it, and so a great search ensued. When I finally got my card back several minutes later it was covered in Taco Bell floor snot--which she made no attempt to clean off.

Then the silly girl was just smart enough to hand me a survey invitation...

And when I got home, got the kids settled, and bit into my freshly prepared Taco Bell items, do you think they were prepared Fresco style?

I'll give you three guesses, and the first two don't count.

Four and a Quarter

2010-10-15T13:53:00.002-05:00

On Wednesday I had an all around bad day. It should have been a good day. I finished up my management clinical, and then my clinical instructor invited a special guest to post conference. The special guest turned out to be the manager of my first choice unit at Gargantuan Hospital! So while I got to schmooze the manager some more, overall my day was still bad.

It all started with this box of donuts...

I have to leave my house very early to get to Gargantuan hospital at the beginning of day shift, so I typically don't take the time to eat breakfast before I go. When I got to clinical, HR was on the floor to do an inservice on upcoming benefits changes. Naturally, I attended as a part of my clinical experience. Well, she brought donuts. She explicitly offered me some, and not wanting to appear rude (and because I hadn't eaten), I accepted.

And it all went downhill from there.

Before it was all said and done, I had eaten 4 of those puppies. Which surprisingly isn't just a huge amount of calories. However, 4 donuts just isn't very much food, not to mention straight carbs gets emptied from the stomach immediately. So even as the sugar rush washed sickeningly over me, I was still hungry. And then the pounding sugar headache settled in.

After clinical I headed to the gym like I usually do and got on the treadmill. I felt awful. I got 2 minutes into my my first 3 minute interval and had to walk. I then slowed my speed and tried running for time and distance, and didn't make it but 6 minutes more before needing to walk again. I had to do that several times. I ended my workout having only burned 400 calories and running 2.27 miles.

Yesterday was a full day of school work with a major paper to be completed. As the day wore on, I became more and more antsy. I finally succumbed to the call of the gym, and had a fantastic workout. 4.25 mi at a 10 minute pace, 840 calories. Farther and faster than ever before.

Little Bear

2010-10-14T09:19:00.000-05:00

One of the great things about being a parent is the tv you get to watch.

Oh sure, point and laugh if you want, but don't knock it until you've seen a few episodes. Shows like Little Bill, Max & Ruby, and Curious George tend to be extremely well written, and a real pleasure to watch with my kids.

However, my very favorite show to watch with my little ones is Little Bear, based on the children's books.

I love the animation. I love the scenery. I love the classical soundtrack that plays in the background. I love the wholesome themes, and the promotion of strong family values.

But most of all I love the sentimentality and the melancholy just at the edge of each storyline. You can feel it in the the tightness in your throat as the storyline whisks you away to the sweet goodness of all that was right with childhood.

Even if you don't have young children brightening your home, take a moment and watch an episode of Little Bear.

Your heart will be better for it.

Honors and the Stink

2010-10-13T10:27:00.003-05:00

I opened my school inbox last night to discover an email from Sigma Theta Tau with an invitation to join. It was an unexpected honor, and it lifted my spirits a bit after the Level II debacle. The induction ceremony is on December 15th, the day before graduation and pinning. At the very least, it's something to put in my resume and CRNA school application. It also may mean I'll be exempt from taking the GRE for CRNA school as well.

The dues are steeeep, and then I have to pay $12 for my purple honors cord for graduation. And another pin for $45. How is it that doing well in school is costing me more money? Doesn't seem right.

In fact, it just plain stinks.

But not as bad as my nursing school shoes.

Part of our strictly enforced dress code (the faculty will actually write us "tickets" that result in being put on contract if we break the code,) calls for 100% white shoes.

I hate white shoes.

But I have faithfully worn my solid white New Balance 622s for the last 2 years, and now they stink.

Nay, they REEK.

I noticed the stench got much worse after Hermine (that b*+ch,) soaked me from brow to toe. And it's quite embarrassing really, but I'll be danged if I'm going to buy another pair of $75 shoes for the next 2 months never to be worn again.

Maybe I'll try soaking them in bleach water. Or maybe that biological odor spray we save for the c-diff patients.

Anyway, that's the Honors and the Stink.