Happy Birthday to me!

Despite the fact that I came home sick from work, I'm trying hard to enjoy that I have the day off (yay for sick leave). My co-workers were so sweet, they were sneakily trying to plan a big party for me but I ruined it by getting sick and going home. :( Bummer, but still how sweet. Now hopefully I can rest up and relax because in a few days I will be going here.

 Hawaii!

I'm excited to go and take pictures and relax for a few days. I will be heading out with my traveling buddy Helena. So, today I will hopefully sleep a lot and fight off this darn cold before we go.

Earlier this weekend we celebrated my birthday because we thought I was going to be at work on the actual day. It was a great day. I got a new dining room table. It was the last bit of furniture we needed for our house and I absolutely love it!

 My friend Joe brought over this amazing wine from his uncle's winery. Hands down the best white wine I've ever had. The bottle is cool too... has a glass stopper. Just another bottle to add to my collection. :)

Also, my friends being the best people on earth... bought me a spa gift certificate to Burke Williams.
Heaven I tell you... pure heaven! I am dreaming about a day at the spa already!

I love having people over... I look around at what I have and how far I have come and I am amazed everyday at just how blessed I am to be able to have a nice home where I can host people. 

I also made my own cake. It's a design I have been wanting to do for a year. I love the movie Coraline (and basically anything Tim Burton) so I finally did it and I just loved the finished product.

Isn't it cute?! It took two days of making fondant and icing from scratch... but thanks to pilsbury I got to cheat and use a mix for the actual cake.

I'm so proud of my Coraline cake!

We ate Mongolian BBQ for dinner and then came back to my house for a joint birthday dessert because my roommate and I have birthday's 3 days apart. It was Katie's real birthday that day. I just kind of high jacked it for myself too :)

Yup, we both turned 26... although I feel like I should be much older than that... because well friends I've lived a lot of life for only 26 years. I have been blessed by them though... let me tell you, I have some amazing, wonderful people in my life.

They are quirky (as you can see) and brilliantly smart and talented and giving and loving. They are supportive and genuine and just hands down the greatest people I know. I consider myself blessed beyond measure to know each and every one of them.

haha, J practicing his dad face...

 These guys have seen me at my worst and yet have walked me through to the other side.

So, today... I want to thank them all for being the best people I know and for being my family and for the grace, wisdom, love and hope they have shown me throughout the years.

I thank my God every time I remember you.   Philippians 1:3

Here's to another great year!

Summer

Summer is winding down...

I'm actually glad... I miss the fall... I'm tired of my room being a greenhouse while I'm trying to sleep during the day... seriously it's so. effing. hot. in my room

One of the downsides of working the night shift I guess...

...but before summer fades away... I'll post some lovely pictures I was able to take of a recent, impromptu, dinner party we had on our balcony a few weeks ago...

there are few things greater than an evening with some good food and great friends

As requested by my roomies, Katie and Sam... (my roommate Sam had run a half marathon that day!) I made my homemade lasagna... and berry oat crumble for dessert...

We had some good wine and blueberry water... an idea I got from here

We sat outside in the warm summer air with candles all around and white lights draped above us...

We put our old wine bottles to good use and stuffed our cheery sunflowers in them...

We even busted out the marshmallows and made s'mores over a small bucket grill that Katie had bought... just for an event like this...

(no one tell our homeowners association... or we might just get kicked out... we already recieved a letter about the lights hanging on the trellis... oops)

Good food... Good friends... Good times

Is it just me or did the summer seriously fly by?

I miss this

Sometimes I get really tempted to just go completely M.I.A and head over to the Rockies.

Anyone else have the sudden urge to go AWOL sometimes?

On Letting Go

There was a great essay in The New Yorker recently about hospice care and terminal illness.
The essay was titled Letting Go, By Atul Gawande an American doctor and writer. The essay is worth reading, but in summary it followed the story of a young, soon-to-be-mother, named Sara and her vicious battle with lung cancer. Gawande recalls his many experiences dealing with patients like Sara... patients at the end of their life and he shared what he has learned and seen first hand being a surgeon. It was an incredibly informative and honest article.

I even learned something new... that atropine helps clear up secretions. I've only used it when my patient is seriously bradycardic. You learn something everyday... even in the most unexpected places. Thanks New Yorker!

Death and dying are difficult topics in health care. I think most of us would say that in one way or another we feel ill equipped to deal with end-of-life care properly. A sentiment that Gawande shares himself....

"You’d think doctors would be well equipped to navigate the shoals here, but at least two things get in the way. First, our own views may be unrealistic. A study led by the Harvard researcher Nicholas Christakis asked the doctors of almost five hundred terminally ill patients to estimate how long they thought their patient would survive, and then followed the patients. Sixty-three percent of doctors overestimated survival time. Just seventeen percent underestimated it. The average estimate was five hundred and thirty percent too high. And, the better the doctors knew their patients, the more likely they were to err.

Second, we often avoid voicing even these sentiments. Studies find that although doctors usually tell patients when a cancer is not curable, most are reluctant to give a specific prognosis, even when pressed. More than forty percent of oncologists report offering treatments that they believe are unlikely to work. In an era in which the relationship between patient and doctor is increasingly miscast in retail terms—“the customer is always right”—doctors are especially hesitant to trample on a patient’s expectations. You worry far more about being overly pessimistic than you do about being overly optimistic. And talking about dying is enormously fraught. When you have a patient like Sara Monopoli, the last thing you want to do is grapple with the truth. I know, because Marcoux wasn’t the only one avoiding that conversation with her. I was, too."

This has always been something that has frustrated me when it comes to dealing with medicine outside of my daily job. I've had multiple friends and family members that have had diagnoses of cancer or other forms of poor-outcome diseases. My own mother has recently been faced with a probable diagnosis of breast cancer...
When it comes down to the nitty gritty... the actual prognosis... I rarely find that a straight answer is given. Often times the doctors I have dealt with "beat around the bush" and do err on the side of optimism. I think partially because of liability issues... telling someone that the outlook is grim before you really, really know is not very wise... but also because no one wants to be the bearer of bad news. There is always, always hope... right?

But at what point are we actually harming rather than helping? The article talks about patient outcomes... with hospice care and without... and also with hospice care early in the game vs. right at the very end of the patient's life. The statistics were surprising... most patients lived longer while on hospice care and most patients seemed to fair better than when they decided to have every medical intervention to prolong life (vs. making life comfortable right here... right now, which is what the goal of hospice is).

"We imagine that we can wait until the doctors tell us that there is nothing more they can do. But rarely is there nothing more that doctors can do. They can give toxic drugs of unknown efficacy, operate to try to remove part of the tumor, put in a feeding tube if a person can’t eat: there’s always something."

I've seen it first hand... those families that just can't seem to let go despite a very, very poor prognosis... the ones that would rather see their loved ones slowly waste away on every medicaiton known to man... on a ventilator with lines coming out of every place possible... skin so edematous and fragile that they weep liters of fluid out daily because their body just can't take it anymore... its not pretty... it's painful to watch and to be honest I wonder if this is really what the patient wants. It's rare that we have a road map to guide us... most families don't talk about these things... and when they do... sadly, often times the wishes of the patient are ignored or at the very least the lines are blurred... and when to intervene vs. when to take a step back... well, who knows?
There were two questions in the essay that Dr. Susan Block, a palliative-care specialist posed to her father when he was faced with a surgery that could possibly leave him paralyzed or dead... I think they are two questions that all of us should ask ourselves and our loved ones...

"How much are you willing to go through to be alive? What level of being alive is tolerable for you?"

Her father replied, "Well, if I’m able to eat chocolate ice cream and watch football on TV, then I’m willing to stay alive. I’m willing to go through a lot of pain if I have a shot at that."

That answer made all the difference for Block when it came time to make some tough decisions for her father and she was sure glad she had asked him those questions the night before his surgery.

At the end of the day, here is what I have learned in my short time being an ICU nurse...

End-of-life issues are incredibly difficult to discuss and are even harder to face first hand... but if I could leave you with anything I would say: Dont wait...

 Don't wait until you or your loved ones don't have a voice... don't wait until you are faced with a crisis and you are bombarded with fear and stress and pain... don't wait until it's too late to have these discussions. It is just too important to simply put off, because really... you never know what can happen... life can change in an instant and whether you want every possible intervention done to keep you alive or you want to live the last part of your life with comfort in mind... what could be more important than having you or your loved one's final wishes being carried out in the way you know they wanted?

Please... don't wait...

For those in the US: resources on living wills and advanced directives

Baby, Get Your Roller Skates On!

Maybe it was because I was just oblivious to it last year.. or maybe it was because I was in my preceptorship or getting easier assignments since I was the new grad. Or maybe I've just been given the rite of passage into the tough assignments (seriously, even my experienced, co-workers have agreed I've been getting crazy assignments lately) but I'll tell you that work recently.....  work. has. been. insane.

I'm talkin' full unit, code bed only, emergently intubating 2 patients at the same time, right at the beginning of my shift - crazy. Hematocrit of 11, post surgical patient...yup, you just bought yourself a ticket to CT scan and guess who's comin' with you? The resource nurse... aka.... me. 3 IV pumps, ventilator, pressure bags, blood warmer...the works...5 person transport team included.... here we go folks... gonna be another busy night.

I think Ive just decided to come to grips with it and I've come to realize that...well..this is the ICU.

I think it's been a factor in my recent feelings of burn out. It's been better, it really has but there are still moments, certain shifts that simply leave you tired and angry and just so over it.

Last night could have been one of those shifts, earlier this week when I was also resource...yup, definitely could have been one of those shifts.... but I hung in there.... I stuck it out.... with minimal complaining too. Despite the fact that I have literally only assisted with one emergent intubation in my entire life. Its not fun... I promise. Can I also add that it included a straight up fight between the ICU team docs and the surgical team of one of our patients. A full blown, yelling included, argument about whether to intubate the patient or not.... meanwhile the guy is unresponsive... making buzzing noises with foam coming out of his mouth.

Wow... I love my job...

But... if anything I'm learning to roll with it... "Get your roller skates on baby!" a friend of mine said last week.
Check and check....  a piece of advice that is so simple yet so valuable.

Get ready to roll with it and when its time... leave the crap at the door. When you go home... you do the best you can to breath and leave it outside.... or maybe stuffed in your locker somewhere at work. Otherwise, I'm convinced this type of job will eat you alive well before you celebrate your five years of service.
Phew... had to get that one out.... at least I'm in one piece and still smiling at that!
Also on a really fun note... saw Step Up 3D and WOW...can I just say
Great music + Crazy-off-the-hook-dancing + some seriously gorgeous boys = great movie to watch after a long day. Totally lovin' the soundtrack to it... can't wait to go running to it soon.

How'd everyone else enjoy their weekend? :)

Living a Single Existence... Part 2

As a continuation from my last post on being single. I think it really embodied a lot of the struggles I have encountered... the gist of what I had felt for a long time. I think it should be noted that the first thing I thought of as being a "bummer" about being single was feeling deficient or pitied... not that it was lonely or that I just wanted to "have someone"... really it was about how I am viewed by the world.

BUT... and this is a big but... in the midst of all of this digging and searching and trying to figure it all out, some really great things have come about for me. It gave me a huge opportunity to step back and really think...
"Okay, if I associate being married with having worth and I associate it with a very strong way of being loved...or rather proof that I am worthy of love...well then, what happens if I don't get married?"

Does that mean I am not worthy of being loved?

Serious question here and it required a serious, honest answer. In having that realization I was able to stand back and really evaluate how I view myself and how I think a lot of single women view themselves as "damaged" goods or unworthy. I think it started sinking in for me before I headed out to Colorado but it definitely settled in during my trip there... just how much I had internalized that thought process.

I have to say that I have been so incredibly blessed with some amazing people in my life who have been able to build me up and show me my worth. Really, more than anything my group of friends and Ami and her family have been probably the biggest factors in realizing.... wow, I am worthy of being loved... and you know what I am so, so loved!

I know... it might sound trivial and kind of cheesy but coming from an abusive background... it is not something that has come naturally. And I think people who have been victims of abuse struggle perpetually with feelings of worthlessness.

So, all that to say that I've come to have a completely different view of my singleness. I don't see it as a deficit in my life by any means. I am so, so thankful for it. I love my life and the freedom I have being single and I feel so much more confident in my own skin. I also think it has given me a completely different view of marriage and the purpose of it. I think the original intent of marriage was about creating a community and a family... and I think I have a completely different outlook on what that means for someone like me who has very little family and is also single.

If I was to ever marry it wouldn't be to find the worth that I now know I can only find for myself and in my faith but it would be to have a commitment with someone that I loved and valued... and to create an extension of the community and family I have with the amazing people I hold so dear in my life.

Truthfully, I doubt I'll ever get married... I don't have any interest in searching for someone or dating really and to be really, really honest... I hate weddings  (I know, probably the only female in the world who does... but they just really stress me out) I will say though, that if I was to get married this is what my wedding would be like... awesome is all I have to say.

I don't know what the future holds for me but I do know that it is hopeful and happy and there are many doors open and so many possibilities. Especially being a nurse and loving to travel... who knows where I will end up? Single or not... it sounds pretty darn great to me :)

If you could see me now...

You would see a big, fat, frown on my face :(

Last week I injured my calf muscle... my Tibialis Posterior muscle to be exact... the right one. Ya, I'm a nerd and looked up the specific name because I had to keep explaining to people that it wasn't shin splints ( unless its shin splints on one side?) and it's been way too long since I took anatomy so yes... I looked it up. In the picture it's the red muscle.

Needless to say, ever since I quit smoking (3 months ago now!!) I have been running... almost every day. I'm up to 3 miles a day now. I've lost weight... almost 15 pounds! I feel great and it has just been such a wonderful thing to get back into exercising. I feel stronger and happier and healthier. Running has become an integral part of my day (and my sanity for that matter)... especially now that I've given up on a serious vice I had been using for almost half of my life... running took the place of my former stress reliever... smoking.

So, you can imagine how incredibly frustrating it is to have gotten an injury that might possibly prevent me from running for a couple of weeks.... no running for a couple of WEEKS? If I don't run for 3 days I get antsy and I eat too much and I don't sleep well... it's really all bad.

SO... here's my question for you guys... I know some of you out there are runners. How do you deal with injuries? Especially muscle strains or possibly shin splints? Any other suggestions for ways to exercise without exacerbating the injury?

image credit

My Trip to Colorado

Colorado has a special place in my heart. I have been flying out there to visit my best friend Ami since 2003... multiple times a year. It is my home away from home. It is my safe place... my happy place. It is where my "family" is...

Ami and I met back in 2003 when we were both doing a missions program with Youth with a Mission. For the first three months we lived in Los Angeles together, then for the last two months of the program  we lived in South Africa, doing missionary work together. South Africa was when we truly became bff's.

After the program was over... we both went home and later that summer she got married (on my birthday!) and I flew out to Colorado for her wedding. I quickly fell in love with her entire family (she has 6 brothers and sisters!) and soon discovered that her husband was basically a guy version of me... I consider him to be the brother I never had. Truly they are both amazing, wonderful people.





Eventually, they began having kids and now I lovingly call them all my "god-children" because there really aren't enough words to describe how much I love those three little girls.  "My-best-friend's-kids" does no justice to what they mean to me.

 Thea, Petra and Ivy

 
This past trip to Colorado was so needed for me... mainly because...well, recently I have been feeling kind of lost and very aware that I don't have a very strong biological family. I have been sorting through my feelings on being single...  and also just wondering... where the heck do I belong? Before I went out to visit them I started feeling very aware of that missing link; the community I did not have... that need for a family. I knew Colorado was where I needed to be.

In my mind.... with Ami's family in Colorado.... is where I truly belong. I have never felt so loved by anyone in my entire life. I know without a doubt that I am accepted for who I am and that when it comes down to it.... they will be there at the drop of a hat for me. They have prayed for me, supported me...financially in times of need, emotionally in times where I was a mess. Ami and I have been there for each other through some of the worst moments in each others' lives and have been able to see each other through to the other side... we call it "walking through the mud together."

This trip was especially great because life for us both has been incredibly busy.... and because we have opposite schedules... we rarely talk on the phone.... we rarely have time to catch up. So, having a solid four days to hang out and talk and debrief was so, so good.

I love it too... because I know that with Ami and Andrew.. I am just understood. They know me... they get me and sometimes there is just nothing that can compare to that.

So that is truly the gist of my trip. I spent time with the girls, playing and laughing and cuddling (they are truly the best at snuggling up and reading or watching TV).

Ami and I shared what had been going on in our lives and in our relationships. We took the girls swimming and laughed and did yoga together.
She showed me all of her beautiful jewelry she had been working on. I shared with her about work in the ICU and what I had been dealing with in terms of feeling "family-less." 
 We went shopping and to the farmer's market and cooked and just had so much fun.

It was wonderful.

Also, can I just mention that being the genius I am... I forgot to put on sunscreen that day at the pool and I ended up with THE WORST sunburn... ever. I always forget how strong the sun is up at that elevation.

Andrew and I were able to get up early one of the days to go hiking together and just had some solid, quality time to catch up also. He's an incredibly intelligent, deeply thoughtful man, who loves God a lot and loves his family with a fierceness I have yet to find anywhere else.

He has been such a blessing to me. Really like the brother I never had but always wished I did.




I consider myself to be incredibly lucky to have these guys in my life and I can't wait to go visit them again soon. Honestly... part of me wonders if I'll just end up moving there someday. It gets harder every time I have to leave... this last time I spent half the plane ride home in tears...
I felt sorry for the guy sitting next to me haha

But seriously...

The thought of getting a little house up in the Rockies and maybe working in some tiny hospital or urgent care clinic sounds really nice these days.

We shall see....

In the meantime, I have lots of great memories and great photos from my time out there and I was lucky enough to come home with tons of pictures to plaster all over my fridge.

Just a daily reminder of how much I am loved...

Living a single existence... Part 1

Lately, something that has been a big part of my life and at the forefront of my mind, is my identity as a single woman. I have been reading a book and a blog written by the author Bella DePaulo; a social psychologist and a happily single woman. Her book "Singled Out," is about how single people are "stigmatized, stereotyped and ignored and still live happily ever after."

Her blog "Living Single" has really confronted many issues I deal with as a single woman.

This whole journey of venturing into my struggles of being a single woman all started when I admitted to a close friend recently (a friend who is marreid btw) that when I am in a group of married women or even women who are engaged... I automatically feel less important. I am an opinionated and independent person and I think as a result, a lot of times, I come off as very confident and strong (even though I rarely feel that way inside) and yet...put me in a group of married women and I will automatically feel self conscious and less important...less valued. Like how I feel or what I think is not as worthy as what a married woman has to say.

Admitting that for the first time was huge for me, because to be honest I don't think it was something I had even openly acknowledged for myself.

 I think for a lot of women...in fact the majority of women in our culture, marriage is something that defines you. Women find worth, value and identity in being a wife or being desired by a man... but it wasn't until I had this conversation with my friend Kelly, that I was able to stand back and really evaluate my view on marriage and singleness.

Shortly after that conversation, I came across a post on the Living Single blog that truly resonated with how I felt. In summary this is what the post was about.

"In Between: Happily Single but Interested in Coupling."

30 single women from the UK, between the ages of 30 and 60 were involved in informal interviews about their singleness. The researcher, Jill Reynolds told them she was single, even though she was married, hoping they would speak more freely to her about the subject.

This is directly from the blog post:

"Reynolds identified four different ways of thinking about single status. (She called them "interpretive repertoires of singleness.")

1. Singleness as personal deficit

2. Singleness as social exclusion

3. Singleness as independence and choice

4. Singleness as self-development and achievement

The women who talked about singleness as a personal deficit were not necessarily saying that they felt deficient because they were single. Rather, they recognized that women who are single - especially past a certain age - are often viewed by others as deficient. Their hesitation in saying that they don't have a partner (even though they already said so in signing up for the research, and even though they were talking to a woman who told them she was single, too) could have been an indication of their sense that their single status was something that needed to be explained. As Reynolds put it, "Single women in effect always stand accused."

...

One of Reynolds' most intriguing suggestions is that there are dilemmas involved in all of the different perspectives on single life, not just the negative ones. Of course, it is painful to be viewed as damaged goods and to be excluded. But women who describe their singleness as independence and as a choice they have made are not home free. For example, others sometimes see them as selfish. Or, people tell those contented single people that they are just rationalizing.

The single women, as I've noted, seemed to feel the need to explain and elaborate when asked if they had a partner. Reynolds found it even more surprising that the women were apologetic when they said that they DID want a partner in the future. Why should that have been so difficult to admit? Why even think of it as an admission?

The dilemma, Reynolds thinks, is that when women "talk unashamedly about their desire for a relationship," they "risk being constructed as deficient and ‘desperate', and marked by their failure to already have a man.""

I think she hit the nail right on the head there... I think in so many ways I have viewed myself as unworthy of love if I am single and in the process have had a very insufficient view of marriage and of singlehood as a result.

I could really write forever about the subject because it is something I have been intentionally sorting through...but I won't go on forever about it in this post... hence this being "Part 1". :)

In the meantime... I'm curious about your view of singlehood? For those of you who are married...did you ever feel deficient because you were single? And those that are single now...do you feel like you are viewed as deficient by others because of your singleness?

New Photography Blog!

 I've been wanting to start a photography blog for a while now... something simple. Just photos and sometimes the stories behind them... maybe eventually photography tips.... but for now a blog solely dedicated to my new favorite hobby.

Come check it out!  The Grey Room

A few things...

Can I just say that I really miss Colorado?

This is me and little Ivy having fun with Photobooth. Photos and posts about that trip soon to come.

On a happier note from the ICU front... the week has been difficult but I'm trying to stay positive... and I've been trying to make a conscious effort to overcome my feeling of burn out (despite the fact that the work hasn't gotten any easier)... and even though I feel just as exhausted and overwhelmed... something paid off.

Last night I was resource and I went into a room of a patient I have been taking care of a lot lately. Lung cancer, stuck in between bipap and intubation....DNR turned full code because the patient's wife... also an ICU nurse... was diagnosed with breast cancer.

He wants to be there for her... so he made himself a full code in order to support her with her chemotherapy. They are both in different hospitals but they talk everyday.

I saw him yesterday and I say, "Hello my friend, good to see you! You look better today."

His response made my day.

"I am so glad to see you.... no really I am so glad you are here tonight... 

You are the best nurse I've had." and he reaches out to grasp my hand as he struggles for air.

I looked at his eyes...so genuine and so very tired... and I almost cried.

This is what nursing is all about.