What is connectivity? 

• Why is connectivity so important today?
• How will communication technology evolve in the future?
• What technology or types of communication do you use to connect with others?

Connectivity is important because it is foundational to human attachment, conversation, and relationships. Connectivity is vital to our health, communication, and collective wellbeing. We have been stripped of our ability as communities, societies, and a planetary economy to connect by traditional means. The global pandemic has redefined how we, as a human race, can connect in meaningful and impactful, yet safe, ways.   

Communication technology is constantly evolving. As the world population grows, natural resources shrink, exploration expands, and the thirst for knowledge continues our reliance on state-of-the-art communication keeps compounding. There is no corner of the earth, perhaps even the galaxy, untouched by dependence on communication. We rely on the ability to share information to keep our economy, commerce, healthcare, education, politics, and global infrastructure functioning. The impact this, or lack thereof, has on human prosperity is astounding. I believe that communication will become integrated, ingrained, touchless, effortless, and most certainly fundamental to our ability to perform into the future. Within this we will be increasingly more connected with minimal effort on the individual level. However, I hope we gain and maintain culturally sensitive and diversely aware communication technology. Without attention to the details, we will certainly loose the individualism that we all value so substantially. 

I used to consider myself a device minimalist. Now I would say that is a false sense of minimalism. While I am not a gamer or social media butterfly, I do constantly communicate with others over an infinite number of devices and platforms. I use an iPhone, which contains many different apps, all of which I rely on to meet my needs. I use a laptop, which contains apps, links, files, drives and other forms of networking, mostly for my job. I use a social media platform, where I share my life with people whom I am vaguely connected to. I stream movies, shows, educational lectures, music, and other various forms of entertainment. The technology I use is extensive and dare I say, a bit intrusive. I am dependent on all of it to function and keep my life organized. My face to face communication interactions have dramatically decreased. I would be lying if I said that I had written an actual letter to anyone in the last 5 years. Mostly my communication devices consist of emails, text messages, posts, likes, comments, reviews, and the occasional phone call, zoom meeting, or Facetime check in.

 

 

 

Please Save My Life

When I step back, when I really look at the place I work, it never ceases to amaze me. Its an intricate network of organized chaos. Its a well oiled gear set on an ever rotating cog of illness verses wellness. It seems we all have a very pivotal role, a very distinct part to play, in this theatrical production of therapeutic remedy. Often I imagine we are a cast of players in this strange episode of "Please Save My Life".

From time to time, I like to take the role of the observer (director). I like to step back, when the opportunity arises, and watch my fellow teammates function. Individually, they are amazing, each knowing the other's strengths and weaknesses. When you have a good crew, you can almost palpate the pulse of their collective heartbeat. They don't have to speak to each other, they just know by a simple nod or half sentence. "April, will you get...". "Got it right here". "Mark I need...". "Here you go, I brought two".

It seems that each person wears his or her specific role like a hand tailored suit. What fits one person well, does not fit another at all, much like the perfect role in an academy award winning film. I have learned that this works well, so long as each person can put the appropriate suit on and wear it well at the right time. It then becomes an ensemble of Armani clad players, so to speak.

As an observer, I have found one true fact which carriers across the board in any ICU setting. We (the collective entity that is an ICU team) are obsessed with labels. Not in the above mentioned name brand sense, but in the "if there is a line anywhere near me or my patient, I will label it at least three times over" sense. We have a habit of paying extreme attention to detail and then controlling that detail by placing a slick little color coded name tag on it.

I remember a specific instance when this observation played out in expert detail. It was like watching a opening night performance of a play I'd seen rehearsed for months. I remember thinking, "this must be what its like for a director when he watches his film for the first time."

Allow me to recap the performance. One night I, the director if you will, was taking care of this particularly sick patient. As the leading lady, she was sick when I started and only became sicker as the night (play) progressed. I had a great team (cast) on that night. Andrew was my leading man. He played off the patients actions with the ease and grace of a calloused veteran. My supporting cast included April, Rey, Jo, and Josh. They all put on their suits and got into their places, not missing a mark or que. April did chest compressions as if fate of the free world depended on her performance. Jo was my scribe, the one writing vitals and events in perfect penmanship. Josh played the gopher, the one sent to gather all the props we would need to successfully act out this play. Rey ran blood and fluid. He was the keeper of the keys, so to speak. Andrew, not leaving his lady's side, ran the drugs. Once my doctors (extras) showed up, it was all I could do to keep each informed, sterile, and equipped. Dr. W put in chest tubes. Dr. M, the attending, called out the emergency drugs. There were blood draws, lab checks, pulses dopplered. Each player laying it all out there, unafraid of the reviews. Each knowing exactly what they had to do and how to do it. There were applauds from the audience when we got a pulse back. There was a hush when the hematocrit came back at 8. There was a silence when asystole fell across the monitor. The production reached a crescendo when Andrew delivered his Oscar winning line. In an effort to control a situation he knew he couldn't get a hold of, we all heard his deep voice quiver as he said, "For the love of Christ, will someone please hand me a label for my Epi drip!?"

You could feel was a cumulative intake of breath; from the cast, crew, and audience of curious onlookers. It was then, at the peak of the performance, the point of no return when Dr. M called a time of death. For all our efforts, we could not save her. Each person slowly peeled off their blood covered Armani suit. Heads held low, they lined up outside the room and took an invisible bow. They exited; stage left, stage right, stage center.

After the code (show), with the curtains drawn and the seats again empty, I was left alone with the lady. She, unfortunately, was unable to leave her role behind. She, like so many others, will be one of the leading ladies we will never forget. She should have won an academy award for her performance...

45 eggs

Whatever the mind can conceive and believe, the mind can achieve.
Dr. Napoleon Hill

My patient was a 50 something year old man. A completely normal person. He is a hard working and devoted individual. He has a beautiful wife and a tremendous family. He is gleefully ordinary. Atypically ordinary. His family mirrors my own. He is just like my dad in more ways than I'd care to admit. In fact, his name was Paul too, just like my dad. Perhaps that is why I decided to take him as my patient. Perhaps it was because I felt like crying every time I hugged his wife, as I would if I were hugging my own mother. For the first time in a long time, I had an emotional response to a patients situation. I truly felt a connection with Paul and his family. He made me feel good to be a nurse. His family made me want to make a difference. I felt like I could really help him and his family. I felt like what I know, what I do, who I am could and would change their lives. I felt like me being a nurse actually would matter to this patient and his family.

He was a very sick man when he came in. He was on three pressors (medications to keep his blood pressure high enough to pump enough blood into his vital organs). He was on a lot of fluid. He was on a ventilator. His arm and leg were infected with bacteria we could not name at first. His family didn't understand what was happening. He had felt ill, like he had the flu. Two weeks later he was in our ICU fighting for his life. As the days turned into weeks, Paul lost his left arm and almost lost his right leg. The infection had seeded in his muscles. For some reason fate had picked him to host a deadly bacteria called hemolytic strep A. Its the same bug that you fight off when you have strep throat. However, for some reason this strain sometimes mutates and attacks the body in varied and unforeseen places, patterns, reasons. We can not predict who will get it, who will fight it off, or who will not. For Paul, it was a pair of aces he could not trump.

Eventually Paul fought his way back from the brink of death. He came off the pressors and fluid. He went to the OR several times over. We did painful wound care three times a day on his leg and arm. His wife never left his side. His children visited him and lifted his spirits. Finally he came off the ventilator and regained a sense of time, realizing he'd missed a month by being sedated and ventilated in the ICU. He had no idea of what he'd been through. As he woke up, he discovered his loss. As he began to recover lost details of his courageous fight, he learned how truly lucky he was.

When I think about Paul and all he'd been through, I cant help but think of what it meant to me as a nurse. I don't mean medically or professionally. From Paul and his family, I learned what it means to provide emotional and spiritual health. Usually this is often overlooked in the medical setting. Especially when you are talking about the intensity of the ICU setting. I will be the first to admit that I hardly ever consider this aspect of health and healing when I am taking care of a critically ill person. When I started taking care of Paul and his family, it was much the same. I knew their faith was strong and their support system was nothing short of amazing. I remember talking at length with his wife about his beliefs and trust in God. I recall accepting what she said and thinking that he'd need a lot more than God to get out of this. I remember telling her what to expect and what would happen next medically. I thought that if I could take the focus to the reality of how sick Paul was then she wouldn't keep talking about God. To switch off the uncomfortable subject, I remember asking her about their kids and how they were dealing with all of this. She said the older ones where a little afraid but that they understood what was going on. The youngest was more concerned with waiting for the Easter Bunny. As she talked of their children, I remember thinking that if ever there were faith to be had, here it was.

I remember the first weekend they came to visit. I knew how afraid and intimidated they would be, seeing their dad in a place like this. My focus switched from Paul's illness to his children's comfort. I had to do something to take their minds and focus off of the horror and fear of the ICU setting. At the ages of 15, 11, and 5, I knew they would be overwhelmed. I asked his wife what he would miss the most about not being at home with his family. She told me he would miss having an Easter egg hunt with the kids the most. It was a tradition in their family for Paul to hide all the eggs and the kids to find them all. She said it gave him such great joy to see his kids looking for all those eggs.

An idea struck me like a bolt of lightening. I spent a couple of hours that night cutting out Easter eggs for Paul's kids. I asked all the nurses stop for a few minutes and help me decorate them. The therapy of decorating a paper egg is completely underestimated. I haven't ever laughed so hard with my co workers as I did that night, huddled over a pile of technicolored paper Easter eggs.

I spent an hour "hiding" 45 eggs in Paul's room. I made a card with the "rules" and put it on the door. When Paul's wife came to visit Easter Sunday Morning, she smiled for the first time since he'd been admitted. She simply said, "The kids will love this". I hugged her goodbye that morning and left for a 6 day vacation.

When I came back, Paul was doing great. He was out of the ICU the following day and as he left, his wife thanked me for the Easter egg hunt. She said the kids were bummed not to have met "the nurse who made all the eggs". I told her it wasn't me, but the Easter Bunny himself. She smiled again and we hugged as Paul was taken to the floor. I asked her to bring Paul and the kids up for a visit when he was well enough to get out of bed. She assured me that they would indeed.

Looking back, I know I found a strength in Paul and his family. I found a faith I tried very hard to deny and an emotion I wanted to ignore. By embracing Paul and his family, I feel like I gave him the best care I could, simply by hiding 45 eggs...

The Jaded Dragon

Am I jaded? Have I lost my empathy? Am I a bad nurse for thinking that I may no sense of compassion for specific sects of humanity? Am I a horrible person because my empathy is directly related to one's productive contributions to society? Before you answer, let me explain...

The other day I took care of a man who is in our unit for the second time in six months. He is ill. He is addicted. He abuses himself by abusing drugs and alcohol. Not an uncommon trait for someone in our hospital. But I found myself asking the question, "why are we treating him again? Didn't he learn his lesson the last time?" I felt like a hypocrite, like a soulless, heartless, horrible person the moment the thought crossed my mind. I felt like a terrible fire breathing dragon. What kind of nurse would think such a thing? It wasn't until I heard two other nurses and two doctors ask the same exact question out loud. These are people I work with every day. These are nurses I admire and respect. These are doctors I trust and rely on. Could it be that I am a product of a jaded and indifferent generation of health care workers? At some point, without realizing it, did I cross over to the "old washout/burnout" realm?

I think not. I love my job, more than ever. I am a good nurse. I find myself looking forward to work. I catch myself praising what I do and where I work all the time. So why was my, why was our, reaction to this man so atypical?

Allow me to lay down the background here. This man is a frequent patient at my hospital. He will show up in the ER high on crack or whatever. He will fake a seizure and request pain medication. The doctors all know him by name. The nurses all know him by his award winning performances. Often he will detox from whatever he is on and leave AMA (against medical advise). He has a strict care plan in place that everyone must follow each time he is admitted to the hospital. He is not a nice person. He is not thankful for his care. He is ruthless, abusive, and mean. He has been blacklisted from all but 2 shelters in the city. This man steals drugs from other homeless people and takes them, regardless of what they are or what they do.

This is a big mistake on his part. He is allergic to a lot of different classes of drugs. He has already had a reaction so bad that all of his skin blistered and peeled off. He was in our unit for weeks. We saved him. We took exceptional care of him. We saved his life. Never a please. Never a thank you. He left AMA--again.

Now, six months later its happened all over again. He took someone else's seizure drug. A drug he is deathly allergic to. He skin has again blistered and peeled off. This time it is much worse. This time his eyes, mouth, lungs, and intestines are affected too. Its a terrible disease, extremely painful and often unsurvivable. He was lucky to have lived the last time. This time, if he survives, he will likely be blind. We are working extremely hard to keep his lungs from failing. Because he has no skin to protect him, he will likely get a horrible infection. He will probably go into kidney failure from all the hardcore antibiotics he will need to fight the infection. We are spending hundreds of thousands of dollars to treat this man...for the second time. And it would mean nothing to me except for one fact.

I am not so sure that if he survives, he wont go out and do this all over again. Meanwhile, we have to cut costs on things like organ donation because we are so far in the red. This is what I question. This is what I don't understand. This is the ethical dilemma I argue constantly in my head. I have asked others in my profession this same question and nobody has an answer. I am not sure there really is one.

I guess its not this patient I am jaded about so much as the bureaucracy of it all. The ethics of treating everyone regardless of station or circumstance used to have no boundary in my mind. Now I question where my boundaries lie. Short changing one to help another wouldn't bother me so much if the other hadn't already been given an extraordinary chance to change and prosper. I just don't see how this form of health care is justifiable. No wonder our country's health care system is failing so miserably. On the flip side of the token, how can we even begin to question the idea of not treating one person for another? It opens a whole can of ethical worms and frankly we have no right. I have no right. Yet, I cant help but think...is this natural selection trying to do its job? Are we messing where we don't belong? Is there a force much stronger than me, than the doctors, than modern medicine at work here? I don't think its a hard question to answer. It doesn't take a rocket scientist to see that its obviously...yes!

Mysteries of the Universe

Wow...its been a year since I started this blog. Its gone by so fast. I have not written nearly enough for all that's in my head, taking up space and energy. That is the point of a blog, is it not? So much has happened in the last year. Looking back, I don't know where the time really went. I guess I can stack it all up to life... Wow!!

Needless to say, I kinda checked out of blogging for a couple of months. My apologies to anyone who may read this regularly. I wish there were some great reason or rational why. I would like very much to say that I was off contemplating the mysteries of the universe with Tibetan monks. Or even that I was discovering lost species in the rain forests of south America. But I can not claim such fame. Rather I have been here, in Seattle working like crazy. It seems that there is always a good reason to pick up that extra shift or work some "Christmas spending" OT. However, the most honest answer I can truly give is this. Late last November, I had a very difficult situation at work with a pediatric patient. I took it extremely hard and didn't really know how to process it. I couldn't talk about it for weeks. I tried several times to blog it out...But every time I'd sit down and start writing, it would overwhelm me and I would loose my focus. It was too fresh and too raw. So, I checked out....Out of most everything. I stopped writing, I stopped making art, I stopped training my dogs, I stopped working out...I really checked out. I dove into work, most weeks pulling in 60-80 hours throughout the month of December. I did take 5 days off and go skiing in Canada. Otherwise, its been work, work, work.

So, here I am, a month and a half later...I am exhausted. I am sore; mentally, physically, emotionally, and spiritually. I am unbalanced. But, now I can write about it. Now its time. I think that by doing this, I will finally be in a position to realign. Its time to get healthy. Its time to process and its time to heal.

Right before Thanksgiving I was working on the PICU. We rotate between the Burn ICU and the Pediatric ICU every couple of weeks. I got report that I would be taking a sick baby. I have come to understand this to be an extremely bold but general statement. Obviously any kid admitted to our hospital and our unit is going to be sick. Otherwise they would be on the acute care floor or at the Children's Hospital across town (Children's does not take burns or trauma--hence our unit). So, knowing that these kids are coming to us is the same as knowing they will likely be pretty sick/injured. As much as I don't want to, I have come to accept this fact.

So, I pick up a 6 week old infant. My report was this: Subdural hemorrhage x2 (subdural hemorrhage= blood on the brain) and possible C1-2 fracture (C1-2 is the top joint of the spine, where the backbone meets the base of the skull). Other, possibly older, injuries by scan and film. CPS (child protective services) is involved. Right away I know this baby is ill. Kids this little don't just "break their necks"... They are extremely flexible (think about how they have been living for 9 months, all folded up and squished during pregnancy)... It takes a tremendous amount of force to break a baby's neck. I say a silent prayer. It was obvious, just from looking at his brain scan that he'd been shaken. This baby has blood in his brain in two places, in the front by the forehead and in the rear just below the crown. I think I was crying on the inside long before I ever laid eyes on him. This baby wasn't even 2 months old... and already he had been abused in such a way it would be amazing if he'd survive, let alone recover.

When I received the baby, he was lethargic and weak. He wasn't moving his left side. We had to intubate him to maintain his breathing. Even the simplest responses were lacking. He was so sick. He didn't move when we poked him for blood. He didn't respond to touch or voice. I doubt he even knew how to cry. Just the thought of that made me cry for him all the more. He had bruises on his ribs, head, and arms. Tubes and wires came and went everywhere. He was too small to put a spine collar on. They don't come that small. We had to use a rolled up pillowcase to stabilize his delicate neck. His brain scans showed he was continuing to swell. Fortunately, babies, unlike most people, have the capacity to swell in the brain. Their skulls are not solid yet, so they can expand. For this child, it was most likely the only thing keeping him alive. He continued to decompensate in the PICU. We had trouble ventilating him. His brain wasn't healing. He wasn't responding as we all wanted, and needed, him to. All he could do was stare, with big brown innocent eyes. It felt like he was screaming at me, begging me to help him, pleading with me to make his pain go away. His expression of lost innocence was almost more than I could stand as a nurse. I have never felt more helpless or more useless, than I did caring for this baby. I could do nothing but stroke his immaculate face and hold his tiny hand.

I'm not sure what made me have such an emotionally charged response. I have been trying to figure that out for nearly two months. We see the saddest of the sad circumstances every day. We've all certainly dealt with worse things. But for some reason, I took particular exception to this baby. I think the worst part, for me, is just not being able to understand how anyone, especially a parent, could ever do this to a child. It makes me angry beyond explanation. The selfishness and complete disregard for the most fragile, the most virtuous, fragment of humanity does nothing less than disgust me. I have a hard time trying to wrap my head around it, even now. On another level, all I wanted to do was protect and help this child. I couldn't even hold him and show him that he was safe. It broke my heart to know that in order to help him I had to cause him pain, above and beyond what he had already endured. On some level, I felt like a collateral hypocrite. With all the intensity of my mixed emotions, I think the most riveting one was love. Undeniable and raw love. If I could have, I would have taken that baby home with me. I am in no positon to have a child at this point in my life, but I know that as unprepared and unskilled as I may be, I could have done a better job-- 10,000 times over.

Its going to take me a long time to sort through the emotions of this case. I guess we all have that one that just gets us. In talking to my senior nurses, they all have at least one, if not several stories just like mine. We eventually had to transfer the baby to Children's Hospital. We were unable to get his swelling under control nor could we ventilate him properly. He did not have a good prognosis. His long term care was better managed at the Children's Hospital.

Unfortunately, I don't know what happened to him. I still think of him often, and wonder how he is doing. I think that's the hardest part in all of this, the not knowing. I have no closure. Nothing is for sure. All I can hope is that he did recover fully. All I can wish is that he went home with someone who will do nothing less than devour him with love...

Quantity over Quality

Last night I had an extremely sick patient. She was a 30 something woman who spent her first hours out of jail injecting her hip with drugs filled with, among other things, dirt. By default, dirt is full of a particularly nasty bacteria called Clostridium. This bug, once introduced inside a person, rapidly and systemically overruns the body, its defenses, and our ability to fix it. The infection she came in with is 100% unsurvivable. No person, ever in the history of medicine and/or IV drug abuse, has ever survived an infection of this magnitude and classification. This woman was no exception. She was dying when she came in, she was dying when I got there. She died under my care.

As it went down, I knew it was inevitable. I knew it was going to happen. What I didn't know was how I would react to it. After five years of nursing, I have come to accept that there are things we have to endure. Death. Death is one of those things. Although some people do it to themselves, I always take it personally when it happens on my watch. My quantity of nursing has taught me many things. Among them, when you take care of someone, its on your oath as a nurse to do everything you can to keep that person alive and make them better. When you cant do that, it always becomes personal. That's not to say I blame myself in any way or have any doubts about my skill. I know I am a great nurse. I know I have a great supporting cast in this theatre of chaos. I don't debate what I do for a living. I would never be happy anywhere else. I always find myself surprised in the most unlikely situations.

What surprised me wasn't the 40+ units of blood products she received. Nor was it the 50+ liters of fluid. I wasn't shocked by the poor blood pressure or the terrible heart rate. It wasn't her lungs being flooded by all the fluid. It wasn't the pool of blood she lay in. What surprised me was my own seemingly anesthetized response to the whole situation.

Let me explain. As she started to code, as her heart slowed and her blood pressure dropped, I went through all the motions. All the right steps. Called the docs. Called the code. Pushed the drugs. Started CPR. Hung the blood. Pushed the fluids. Prepared for the chest tubes. This is what I do. This is what I love. When you are in the middle, there is always that stinging feeling of someone else's life in your hands. Usually, I cant help but feel a buzz, sense of euphoria, a slight tremble of hand. But this time was different. This wasn't how I normally feel. Through it all, I couldn't help but feel paralyzed. I did everything I was supposed to do. And yet, I felt nothing. I just remember thinking, why are we doing this? Why are we wasting so much on something so futile? Why are we so driven by quantity and so completely detached from quality? We knew before the code even started that she was going to die. And yet, we felt justified in pumping liter after liter of fluid into an already flooded body. We compressed and bagged an already lifeless soul. As I stood there next to the doctor, all I could think was that we are truly selfish beings. We are so wrapped up in what we can do, we don't stop and think about what we should do. We want totality. More, it seems, is better.

What about dignity? What about grace? What about plausible outcomes and quality of life? What about the baby in the ER who needs that blood? What about the teenager in the trauma unit who needs that fluid? Did I give my patient the best care by doing everything? Did I give her the dignity she deserved by letting anyone who walked by into my room to compress her chest? Does being a great nurse really have anything to do with quantity??

I say no. No it doesn't. Being a great nurse has everything to do with quality...

The Sound of Music

I love music. I think it is one of the most amazing gifts to have and receive. I would like to say its a gift I can give, but unless you are strictly talking about buying a c.d. or an i-tune, then I am not the person to go to. I cant carry a tune in a bucket, even with a lid tied on. However, I am not afraid to admit that I cant sing. I am okay with the fact that I will never win a Grammy or be on Broadway. I sing anyway. Although I sing badly, at least I sing loudly. Music has always been a big part of my life. Growing up, my Dad taught me to love the best and greatest of the 50's, 60's and 70's. My Mom taught me to love opera, show tunes, Sinatra, and country (you can take the girl out of Montana, but you cant take the Montana outta the girl). Grandpa showed me the beauty behind classical. My brother played the drums, so from him I learned to appreciate metal, jazz, and rock. In college, I was introduced to punk, ska, hip hop, and alternative. And, on a personal note, 2 of the last 3 guys I have dated have been musicians. I guess I have a thing for guys with a guitar.

Back to the point, music is so important to me, sometimes its even more enticing than food and water. There isn't a day that goes by that I don't hum along to a tune, turn on my i-pod (I know, I am a material girl in this material world), or flip on my radio. Music not only inspires me, it motivates me. Its a driving force to my existence and something I fear I will miss greatly when I leave this life behind. Regardless of the situation, no matter what is happening in my life, there almost always is a song that relates to or embodies the emotions of the moment. I think music is a way of personifying emotions we cant verbalize. Its a physical way of showing others how we feel. Whether it be happiness, sadness, pain, pleasure, grief, lust, heartache, love, humor, or even nothingness; it can almost always be translated to music. I think what I love the most is that music is a true universal language that spans every culture, every continent, and hundreds of years.

When it comes to music, I have had the same conversation with all my friends and even strangers. I love to hear what people say when asked the same question, "If you could have a soundtrack for your life, what would be on it?" Most people don't answer right away. I have heard all kinds of different answers. Mostly its mainstream pop culture tunes that are popular here and now. Some put a little more into it and rattle off some classical pieces or religious hymns. Some just make a list of old school favorites. Very rarely am I actually taken by surprise. When that happens, it honestly gives me goosebumps.

The power of music is something that always floors me. I always have a play list going in my head. Even in the most tense, high stress, hopeless situations, I can hear a song somewhere behind my ears. I think its a way for me to cope and filter. Its my way of letting only the necessary information in and keeping the useless out. Whatever the cause or rationalization, I know that the day I stop hearing music is the day I find my way home. So, whats on my soundtrack?? Well, its an incomplete list, but its along these lines: 1-big eyed fish. 2-amazing grace. 3-fur Elise. 4-the dawning of the angel aquarius. 5-map of the problematique. 6-what a wonderful world. 7-let it be. 8-for you. 9-into the ocean. 10-story of my life. 11-walk the line. 12-tomorrow. 12- into the west. 13-drift away. 14-have you seen the rain. 15-young folks. 16-no rain. 17-black door. 18-steady as she goes. 19-its your love. 20-them bones. 21-the cowboy song. 22-crash. 23-walking on sunshine. 24-imagine. 25-closer to fine...

The Hamster Wheel

Recently I was reading an article about nursing in the coming decade, the extreme shortage of qualified nurses, and the work load we deal with on a daily basis. I was taken aback by the statistics, as well as my own realization that I too have fallen through the camouflaged trap door of overworking myself.

When I stopped long enough to think about the stress and expectations that my job, my responsibilities outside of work, and my lifestyle require, I realized none too soon- or perhaps just little too late, that I am gambling on a slanted table. Things do eventually roll downhill.

Just looking at my job alone, I can now see how much of a drudge to the system I have become.

I used to have romantic notions about my job. I would like to think that they still, in some muted subconscience capacity, drive me to come in every single shift and fight for what matters. I know in my heart of hearts why I do what I do. I know what really matters to me. I know I am a good nurse, well educated and willing to fight for my patients no matter what. However, after much reflection, I have come to one simple discernment. We; be it nurses, business folk, laborers, blue collar, white collar, black collar, whomever works hard for a living; are like hamsters on a wheel. We go forward each day, each night, each shift. We drive ourselves on for the remote or even unobtainable goal of "the end". We know that if we work hard enough, the reward of a good day will greet us happily, like a lap dog who waits for his biscuit. Our "end", however it may be, is our treat. But what I have come to understand is that there really is no end. One may live. One may die. One may never be functional again. One may recover fully and completely. However the chips may fall, however hard I work, I do not embody the capability of change the outcome of fate. Ergo, I can not change the fact that there will always be more to come. My job doesnt end when my patient dies, or when he goes to another unit. My job doesnt end when I drive home, no matter how blurry eyed and exhausted I might be. I am always a nurse. 24/7. 365 days a year.

Within this realization, I find my inner monolog singing through. I say it to myself mostly, but also without any reservation to anyone willing to listen, "I, or we rather, have to find a way to step off the hamster wheel from time to time." I have to find a way to take a step back and focus on the one part, the one person, in my life that I so often readily ignore--me. So, I have started a list of things that make me "jump out of the hamster wheel" and focus on just what I need. For instance: I can spend that spare 10 bucks I have on some fresh flowers, instead of a coffee and bagel on my way to work. I can turn off my phone for three hours and take my dogs for a hike rather than sitting and waiting for "that" call. I can enjoy a glass of wine and be okay with the fact that tonight is my night off.

I think its very important, for myself, all nurses, all people stuck on the hamster wheel of life; to take a step back, jump off and even turn away from the perpetual chase and focus on what really matters. If even for a few moments, its neccessary to find a balance and release yourself from the eternal race to "the end".

Mr J's Triumph

Its been way too long since I have written anything, let alone a good blog. I would like to think I have been accomplishing something great. Truthfully, I have been out enjoying the sun and surf. I have been training my new puppy how to sit. I have been out with friends and living life, enjoying the summer in the city. While out enjoying the beautiful weather and scenery, I was thinking about whats been going on lately. I began to reflect heavily on what I have learned, what I will never forget and how my life as an ICU nurse has changed in the last few months. I think I have finally come to grips with the changes and expectations of being a trauma nurse in the burn/pediatric ICU. Looking back, I see the shell of a young, apprehensive nurse. Looking ahead, I see the shadow of a great, well rounded and experienced nurse. I realized, that while I still have a lot to learn, I am not the one asking all the questions anymore. People now come to me and ask me the questions I asked but a few short months ago. What a tremendous shift of perceptibility.
There is one patient that comes to mind when I think about my personal shift in guise. While taking care of Mr. J, I distinctly remember the exact moment when I said to myself (with my seemingly very audible inner monologue), "Holy crap, if I don't step it up here, and run this theatre of mass chaos, he is going to die"... I said this with my hands buried up to mid forearm in his dehissed hip incision. Bleeding out, on a heprin gtt, I fought with the idea of letting go of pressure to reach for the code cord. Instead, I exercised my full lung capacity to anyone in a 4 octave range. Marne, the charge nurse, was the first to arrive. She took the situation in hand while I shouted out orders and expectations to everyone else. Eventually, I got on the phone with the operator. After that, everyone and their mothers...including the Gen. surg docs and ortho docs with their minions, I mean, med students in tow, showed up.
By the way and for the record, paging supposedly important people at 0300 STAT overhead does have a certain degree of wicked satisfaction. At one time, 5 docs showed up, asking questions and demanding answers...I felt my patient swirling and my mind clouding over. After 20 minutes of this and that, should we, will we, how did this happen, what did you do??...I stopped, kicked every single person--doctors and nurses, med students and MAs alike out of my room. After I got my patient settled and retrieved his family from the waiting room, I stepped outside. I sat with the R3 of the ortho team and explained for the umpteenth time what happened...
While he listened to me, I could tell he didn't believe or care about what I was saying. I stopped and walked away. When he questioned me, I looked at him point blank and said, "If you don't want to hear what I have to say, then I am not going to waste my time talking to you. I have a patient to take care of. I have a family to explain to. I have an attending, in fact, I have your attending, to call. I need to tell his family when he is going to surgery. Unless you have something earth shattering and otherwise important to tell me, then I think we are done here." With that, I turned my back to him and walked into my patients room. I knew that I had overstepped my boundaries (as classically defined by disciples of the"old school" paradigm) as a nurse. I knew my manager would hear about this. Secretly, I hoped she would. I imagined, as I walked into his room, what she would say when I got pulled into the office and asked what really happened. He was wrong, I was right. I finally realized that it is my job to stand up and make decisions for my patient, even if that means going against authority, even if it means barking orders or reaching outside of my scope of practice. Doing what it takes to keep my patient safe, to keep him alive, is what it truly means to be a great nurse.
Until I stood up to that arrogant physician, I didn't know what it meant to really define my arena of practice. Until that moment, I hadn't been able to define what it was that makes me fight so hard for my patients. Now I know that its not about who does what or who's role is more important. Its not about my license or their title. Its not about me or them, doctors or nurses. Its about whats best. Its about what I need to keep my patient alive. Its about my ability to trust that everyone involved will support my ability to take care of my patient to the Nth degree. Being able to stand up for myself, my decisions, my role, and my judgement meant I was standing up for my patient, his rights, his needs, his life. In the end, I knew I was right and that my patient was the better for it. I have no regret, no reservation, and no doubt. In hindsight, I flourished as a nurse at that moment. To me, Mr. J's triumph will always be my triumph.

Best Moment in Medicine

I was watching an old episode of "Scrubs" the other day. The topic of the show was 'Whats your best moment in medicine?'. I thought it was an interesting subject to blog about. When I stop to think about it, there isn't anything or any one specific instance, patient, or case I can recall that stands out as my personal best. I think there are many reasons for this. Mainly and most obviously, its because I don't do this for me. There is nothing about nursing that makes you do it for yourself. There isn't glory or badges to be earned. There isn't a big paycheck or a huge bonus waiting at the end of the week. Nursing is a selfless career filled with the most giving and unselfish people I have ever met. On that note, I also think there are so many wonderful, insightful, heart warming, heart wrenching, moving, jarring, and fundamental life changing moments to choose from, its really hard to pick just one and pinpoint it as my best.

If I really sit and think about this question (and I have--A LOT), then it becomes quite clear to me that the only possible answer isn't one big moment, but many small moments combined into a huge life lesson.

There are the tears of joy and the tears of sorrow. There are the moments of doubt and the moments of confidence. You feel the duality of every emotion imaginable. You question everything about yourself, your career, your choices and your ability to keep on fighting the good fight. Its at these junctures when you really find your personal "bests" in medicine. Each moment where you sit and ponder your next step. Each time you take the time to hold a hand or wash a face, its your best. I find its the small things that really make me feel the best about my job. Titrating drips, pushing meds, doing chest compressions, giving blood, replacing electrolytes....that's all part of it. But for me, my best moments come from things like painting the toe nails on my teenage girls', or holding the babies when they cry at night, or holding the hand of an old lady who is scared by the shadows. For me, being a nurse isn't so much about my best, but rather my patient's best moment.

One thing I can recall is not something I did. Its something I witnessed. One particularly bad night, I was walking down the hall toward the nurses station. We were slammed with some really sick people (several burns, a post code, a couple of kids, and some other trauma sickies). I was on with a great crew and I knew that no matter how deep we where in, we would be okay. But when you are that busy, you don't think about that final hour until its already gone. You focus on the tasks at hand and only see what you have left to do. I was focused on my patients crazy labs and what I would do next. While passing a room with a particularly sick patient, one whom suffered a head injury, I heard not the silence I expected, but this hauntingly beautiful song. It was Tura, Tura, Tura, an Irish Lullaby. I stood in utter amazement at this gorgeous song and thought that there would never be a more appropriate time to hear such a melody. I felt like I was in a trance, with all the other nurses whizzing by me. It was Val, one of our most experienced and outstanding nurses. She was singing to her patient, a song he hadn't heard since he was a child. He laid there quietly (something we all hadn't seen him do since his head injury) and listened to her sing. He cried when she finished, saying that his mother used to sing him to sleep with that song. He promptly (for the first time in weeks) fell into a peaceful sleep. At that moment, watching Val give her patient the one thing medicine itself could never provide, I knew that this was my best moment...