Sunday, October 31, 2010

Happy Halloween!

 My roommate's crafty pumpkin :)

From my home to yours... hope you have a fun and safe halloween!
Are you dressing up? Going trick or treating? 
I sadly will be at work... hopefully it won't end up being a complete nut house! :)

Thursday, October 28, 2010

Home is where the heart is...

I hate moving.... with a passion.
I don't know any person who enjoys moving... but seriously... I really hate moving.
House hunting, signing leases and figuring out a new area.
Taking everything down off the walls and living in a bare and empty house, unable to figure out where anything is for weeks before. Navigating around boxes stacked all over the house and actually finding enough boxes to fit all of those last little bits of things you never even knew you had. 
Unpacking that takes an entire month and trying to decide what to keep and what to get rid of.
I hate it.

I have moved 3 times in the past six years and come this December that tally will increase to four times. The house that I am in now I moved into just this past December and minus the annoying H.O.A. and the fact that my room is boiling hot in the summer... I have fallen in love with this place and the thought of moving again makes my stomach turn. Now I know that moving three times in 6 years is not bad for some people but the moves I have had to do have been horrendous.

I had anywhere from 4-6 roommates, with a relatively large house and a PACKED garage and the process of sorting through who's stuff is what and which house it goes to and who's responsibility it is to clean what and sort through what... ugh.... it. was. a. nightmare.

The last house I moved out of was probably one of the hardest moves yet. It was a house of people I had lived with for the past 5 years and it was heartbreaking and seriously drama-filled when the house split up. I still close my eyes and cringe everytime I think about it.

So... all that to say when I moved into this house last December... I was planning on staying for a long.... long time. My rommate Sam and I have been living together since I first moved out on my own at 19 years old. That's about seven years! When we moved to the place we are in now, we added a friend of mine from highschool... a girl I have known since we were little and a friend of Sam's as well.
Katie and I go way back to our highschool field hockey days and years in youth group at church during junior high and on.

Mine and Katie's plan was to keep this house until one of us got married and from the looks of it... we figured that would be quite a while considering the luck of our love lives.... (seriously we both had an uncanny ability to pick some real "winners" if you know what I mean)
well... somewhere over the course of a year I decided that I probably just wasn't the marrying kind and she decided to go get herself a serious boyfriend that she is now living with... much for the plan.


So here I am... prematurely grieving the loss of another house that has just become home. Understanding that I have serious attachment issues.... I just can't seem to let go of anything or anyone these days. Change feels so earth shattering and I've been feeling extremely vulnerable lately...
I think I really just want to grow roots somewhere.
I've been finding some places online with great potential but despite that, my heart sinks everytime I walk through my house and look at the things I will probably have to give up.
My wonderfully large kitchen with a gas stove and a beautiful bay window that overlooks the trees and streams in light while I cook.
The peaceful view I have from the balcony off of our living room. The water that reaches right up to the deck below us.

Our neat, little living room with our cozy fireplace and vaulted ceilings...

But most of all I think I will miss the memories that have already been formed in this house. The birthdays, parties and get togethers. The excitement of having my first "grown up" house on a nursing salary, with nice furniture and that welcoming sense of pride I carried with making this home. The sense that I have finally... finally arrived to where I have wanted to be for so very long.
moving. just. sucks.

So... for now I am enjoying the last few months in this house and I am praying that this next move will truly be the last for a very long... long time.

And I'm hoping that somewhere beneath it all, there will be a lovely silver lining amidst the dark and gloomy clouds... and who knows... maybe this next house will woo me to love it even more than the one I am in now... one can always hope, right?

Monday, October 25, 2010

Weekend Re-Cap

First things first! Congratulations to one of my favorite co-workers and blog readers... Mrs. Tricia Williams, your wedding was beautiful and ridiculously fun (maybe too much fun!) and it was so great to be apart of something so wonderful. Wishing you many, many happy and fulfilled days to come. You're a wife now! :D
Some of my favorite work folk :)

We definitely knew how to party it up and it was a blast to get together with my nursing buddies and cut loose. Working in the ICU can be crazy and it's nice to know you can work hard and play hard together too. This lovely woman here below is my friend Teresa... my running inspiration. She started running about a year before I did and has always been such an encouraging force for me. Love her :)

One of the greatest ideas for a wedding ever... the photobooth.
I didn't jump in on as many of these photos as I thought I would but it is seriously so much fun. Last year when one of my best friends got married she had one at her wedding and my group of BFF's went crazy all night.
Such good memories and a great way to have photos of it all!

So, since I got back from the wedding yesterday I've been a complete lazy bum....I'm not gonna lie friends.... I've done virtually nothing productive in the past 24 now I'm off to get up and clean or run and get ready for work tonight....or something to that effect. :)

How was everyone else's weekend? :)

Friday, October 22, 2010

Colorado in Autumn

I love autumn. It's my favorite season and it is no wonder that Colorado is incredibly beautiful during this time of year. The Aspen trees turn a beautiful bright yellow color; bursting out of the mountains like oil covered paintbrushes. Truly, the Rockies this time of year are breath-taking.

It was a wonderfully relaxing weekend. Thanks to Ami's husband Andrew, Ami and I spent a night up in Vail in a gorgeous resort that had a wonderful spa. A spa we took full advantage of. It was pure heaven to escape to the middle of the mountains with my best friend. I can't remember the last time we had a full day and night to hang out and just catch up. It was glorious...
The view from our hotel showed the adorable resorts throughout vail and a peek of the mountains with those bright yellow Aspens I so dearly love. The room itself was amazing! I would die to have a bedroom and bathroom like this in my house. Seriously, what a treat it was!

The girls, as usual were the best. It's always so amazing to see how fast they grow. It seems that everytime I go out to visit, I've missed so much... and they are already so much bigger and are growing so much faster. "Why are you so big?!" is a sentence I say often. It is really great though, to be able to be apart of their lives in such a close way. To matter that much to them and to have them matter that much to me... seriously I love these girls as if they are my own and being there for the little moments are so great. Even if it is just a haircut and a ride on the carousel at the mall. :)
I have lots more Colorado photos you can see here. For now I will leave with you a piece of the gorgeous Colorado Rockies.

Happy Friday Friends!

Tuesday, October 19, 2010

Nurse Down

Idaho Springs, CO

Well friends, I've made it home from Colorado in one piece but it was quite a feat I'll tell ya. I ended up getting sick the last day of my visit and by the end of the day had landed myself in urgent care. It began with me waking up at 5am, nauseous as ever and throwing up that morning before leaving for the airport. I just kept thinking, "Okay, please Andi...just make it through the flight without throwing up." I hadn't eaten anything that morning cause I was afraid I was gonna end up regretting that later, so by the time I got to the airport I was pretty out of it. When I stood up to board the plane I began feeling really light headed and everything around me became muffled... as if I had noise canceling headphones on. I was instantly drenched in sweat and felt so dizzy I decided that it would be a good idea if I sat down on the arm rest of a chair near the boarding line.

Next thing I know I wake up on the floor with some lady nudging me, asking me if I had tripped or if I had just passed out? I, being determined to get home, mumbled "yeah" and proceeded to get up and get on the plane.... completely confused and terrified at what had just happened.

To make a long story short I ended up calling my bff Kelly and had her pick me up and take me to urgent care when I got home. Seriously, thank goodness for my friends because its moments like this where its really tough to be single and not have family that you can count on. Poor Kelly sat in the waiting room for hours while I got worked up. It ended up that I just caught a nasty virus and combine that with the altitude change in Denver... made for a severely dehydrated mess of a nurse. EKG, labs, meds and 2 liters of fluid later I was sent home to sleep and try to start eating again.
I'm still very weak and dizzy when I stand up but at least I'm keeping down food and fluids! I'll do a Colorado update soon but for now I'm gonna go back to sleep and try to get some strength back before I have to work tomorrow!
Have a good day friends! Hope your week is going better than mine:)

Saturday, October 16, 2010

Why I love working in a teaching hospital

My hospital on the fourth of July; every holiday they bring out these flags and it never ceases to take my breath away.
When I was a student working in the ICU, I remember something that was so exciting about learning in this environment was the fact that we were in a teaching hospital. Most of my clinical experiences… actually probably half of my nursing education was done in the private sector which is completely different from a teaching hospital. In a private hospital you don't deal with residents, fellows and interns… most of the time you deal directly with attending physicians and for nursing, this usually means a lot more of directly following orders and a lot less collaboration and less of a team approach to patient care (at least that was my experience)… so when I came to the VA and started in the ICU it was such an exciting and encouraging place for me because I instantly saw the value of multidisciplinary care and nursing input during rounds was welcomed and even expected!

Now, of course with all good things, there comes a downside. I also quickly discovered that working in a teaching hospital meant that we would be forever working with people who are learning. The direct impact on nursing is that we have to be incredibly diligent about checking and double-checking orders or things that seem strange. One of the best lessons I have learned is to not assume or take anything for granted. If you don't feel right about something… stop and listen... even if it's in the middle of a code because that single minute you stop to double check, could be the one thing that prevents someone from making a huge mistake… but I digress.

This past summer has been a tough one in our ICU because I think a lot of the nurses on our unit are seeing the impact of the teaching aspect of our job. It's strange because there are many, many times when we will be working with physicians who quite literally have no clinical experience or have never worked in an ICU at all. A lot of times this means that the ICU nurses will often have years of critical care experience with knowledge to draw from that the ICU residents/interns just simply don't have. This is one of the downfalls of working night shift also… you have an intern and a resident on call overnight… if you don't agree with their orders or a judgment call they've made… well that means you are paging your fellow and sometimes even your attending at 4:00am, at home. I unfortunately have had to do this multiple times in the past few weeks and it hasn't been fun… at all.

For months…since the new batch of docs started in July, it's been a whirlwind of long nights with unsure interns and lackadaisical residents who are so scared to do anything that I end up having to go up the chain of command to get anything done… and let me just say that for an inexperienced nurse, it's really hard to learn to trust your instincts with this stuff. When I page the fellow I'm basically saying… " Hi, ICU fellow… I know it's 4am and you're trying to sleep but your intern or resident said to do fill-in-the-blank … or they aren't doing anything about fill-in-the-blank… and I think they are wrong, so I've decided to go above them and get a better answer (hopefully) from you." Yikes… scary.

Well… all that to say that finally... finally… there is justice! This week we got a new cardiothoracic surgery fellow. I love cardiac surgery patients, so when we have a crappy CT fellow it can make or break my day. Luckily, this time our CT fellow is completely awesome. Incredibly competent, very personable and works so, so well with all the services and nursing staff. Seriously, this week was one of the best I have had in a long… long… time because I had one of his post-op surgery patients the entire week and working with him was such a joy. It reminded me of why I love working in a teaching hospital so much. It brought me back to that original excitement I had when I first started in the ICU and when I first started working with cardiac surgery patients in particular.

A moment I will remember for a long time coming… it was the second day I was working with the patient that had a 3 vessel CABG with a post-op course that ended up having some major complications. This guy bought himself 3 IV poles worth of drips, continuous cerebral perfusion monitoring and a bunch of other complicated things that I won't go into here. To put it bluntly… this guy was sick.

There were a few things that our ICU team had asked me to do that didn't make sense to me and so I started to discuss it with the CT fellow. We started talking about the plan of care and quickly discovered we were on the same page about everything and all of the stuff I was hoping to do (and not do) he was completely on board with. It was a totally collaborative, peer level dialogue that I haven't had with any of our docs in a while.

"Awesome!" I said, "No fighting to get what I need for my patient. Today is gonna be a good day."

What he said next was one of the best compliments I've ever gotten…

"Andi, seems like you've been doing this for a long time."

"Nope, I've actually only been a nurse for a little over a year… I just love cardiac patients. I think it makes a difference when you love what you do." I said with a smile.

Then he says… "You graduated and went straight into the ICU?! That's crazy! Well, it's gonna be a great couple of months for me if you're gonna be here. If you need anything else just call me directly."

Sweet… my day just got even better. No arguing, no fighting, and I had just been complimented by one of the most competent CT fellows I have ever worked with. This is exactly why I love working in a teaching hospital… the collaboration, growth and encouragement that can happen here… well, my job could not have gotten any better at that moment. :)

Monday, October 11, 2010

On Growing Up

Recently, I was reading a great post on one of my favorite blogs,  Reflections of a Grady Doctor.
I always love her posts because she is an amazing physician who writes from the heart and obviously cares a ton about people and especially her patients. She's a great example of how I want to be with my patients.

If you have time, check out the post and her blog because it is definitely worth a read. Anyways, without trying to summarize the whole thing, I will just say that it got me thinking. It got me thinking about how I am as not only a nurse but as a team player and a woman in general. I tend to be pretty feisty and hard headed sometimes. I'm completely type-A... a certified control freak. I'm also a fighter, a survivor. I've had to be and I think because of that... because my life hasn't been easy, I tend to become defensive when I feel opposition.

Somewhere along my 26 years of living I became cynical of the world. I learned very quickly that people, more often than not... are not trustworthy... people, more often than not will abandon you at the first chance they get.... people.... well.... people hurt.

The good news is that through a lot of conscious effort and healing and prayer... I have become a much less jaded and cynical person. I'm not nearly as angry as I once was. I have a lot more patience and I have learned that pride comes before a fall... a very long and hard fall at that.
But, sometimes I feel those deeply rooted fears and insecurities rear their ugly head. Sometimes, I feel myself becoming defensive, guarded and confrontational.

When I have difficult patients (and that can be a frequent occurrence at the VA) it can be really hard not to get frustrated and become a mechanical nurse, going through the motions but not really caring about the person in the bed.... because they said something mean or were disrespectful.
When I have to work with physicians who are rude and demeaning... or co-workers who are harsh and critical... my walls come up. I will be short with you and you will bet that you won't get any compassion or understanding from me.

I don't want to be this way and I've been thinking about it a lot since I've read that post on grady doctor. 
You know what I've realized?

I don't trust people... I don't give them the benefit of the doubt. I assume... almost always, that people are not on my side.... that people are my opposition and it makes for a very defensive, confrontational person, nurse, friend, daughter etc.
It's as if I go into fight or flight mode and if I'm not able to pack my bags and run... well then you better be ready for a fight mister. When I'm faced with confrontation or opposition, everything in me feels threatened.... afraid and small.
I don't like feeling small.

So either I fight or I run, and rarely are either of those the best option. There are times when I need to stand my ground, and there are times when I need to have solid boundaries. There might even be times when I need to be very assertive, but what my hope is.... and what I think I'm starting to grasp as I get older... is that fighting is not always the answer, and that people are not my enemy.
People are the reason I am a nurse, and people deserve to have the benefit of the doubt.
And that includes myself.

And now... when I feel myself tightening up and my defenses start to rise... I take a moment to stop and pray. I take a moment to stop and really think about why I am reacting this way.
And most of the time it's because I feel belittled, hurt or disrespected...
and its out of fear or shame that my angry, feisty, walled-up Andi comes out.

And even though it takes a lot of effort and an active, conscious, decision not to react to those moments when I feel that wall coming up... I can already see a difference in my life and in my work... and for that I'm so thankful because its bringing me one step closer to the woman I want to be...loving, kind, patient, humble and forgiving.

oh, the joys of growing up....

Friday, October 8, 2010

Week Re-cap

Monday: Stayed in bed all day because I was so sore from the half marathon that I could barely walk. Fell asleep at 7:30pm because I was so exhausted.

Tuesday: Woke up at 6:30am (yup thats 11 hours of sleep) cleaned my house and then went to work that night and found out that a patient we've had on the unit for months coded over the weekend and was now on comfort care :(

Wednesday: Went home after work and since I had been up for over 24 hours at this point slept from 10am-530pm (miracle!) and then had a paired assignment at work that night that was really busy. One stable patient + one intubated patient with respiratory failure, acute pancreatitis and was now becoming septic very quickly with an elevated lactate and a pH of 7.17, CO2 in the 70's and a paO2 in the 40's.... ended up having to go above the intern and resident (they said that the blood gas "looked fine")and paged the ICU fellow at 4am.... not my idea of fun.

Thursday: Got into an accident in the parking lot at work and then had to go home and deal with insurance etc. Didn't sleep more than 4 hours and then went back to work for my 3rd 12 hour shift in a row. Survived 4 hours of our unit's annual competency fair and then had my septic patient for the next 8 hours.... luckily we had him completely sedated, paralyzed, on a ton of drips and even though he was still sick, sick he held steady all night .... my favorite kind of patient :)

Friday: I come home from work this morning and fall asleep from 10am-11:30am and have been awake ever since.... I've desperately been trying every trick I know to get some rest... meds, hypnosis tapes, guided meditation, eye covering, ear plugs, watching tv, reading.... still. wide. awake.

Since Monday morning I have had a total of 24.5 hours of sleep = I'm averaging 4.9 hours of sleep a night = I'm not a happy camper.... plus I have been too tired to go running this week and it's just making me more grumpy.

Another thing I tried to help me fall asleep was to look at pretty pictures of fall and rainy season.... fall is my favorite season and I would be the happiest person ever if it rained 24/7... seriously I love rain.

   There is something about fall and about rain that is so comforting to me.

On an unrelated but happy note... I get to go to Colorado in a week! It'll be great to see it in the fall cause after all these years I've never been there during the fall. Plus I'll get to see these guys :D
Happy Friday Friends!

Sunday, October 3, 2010

I just ran my first HALF MARATHON!

I just officially survived my first 13.1 mile run!!!
 That's a half marathon in
2 hours 29 minutes and 52 seconds!!

Five months ago I was a smoker who didn't exercise and couldn't run more than a half mile without having a severe asthma attack and now I am a runner who finishes half marathons! 
When I lined up for the race I was nervous. Unkown situations always make me anxious and I had never run that much in my entire life. I was afraid I wouldn't be able to finish or that I'd give up and walk most of it or that I'd end up realizing I was SO out of shape I'd be in the first medical station they had along the race. I had been resting the past few weeks because of my injury and I was afraid that might flare up again too (luckily it didn't at all!). I was so nervous that I woke up at 3am the morning of the race and couldn't go back to sleep!

I finished it and I walked maybe a total of 5 minutes the entire race.

As we lined up in our corrals and waited for the gun to go off, I began to look around at the people near me and I realized just how far I have come. I was standing next to a lot of people who were championing their health and now I was one of those people too. 
That's me in my new shirt, very excited after the race! 

One of the best parts of the race (other than the finish line) was when Katie, Sam and Martin (current and former roomies) and Sam's friend Lindsay came out to cheer me on. Sam had told me that he would be right after mile 5 on the sideline. It honestly kept me going through those first couple of miles where it already felt really tiring. As I rounded the corner on mile 5, I see Martin peering out above the crowd (the boy is tall) and then Lindsay and Sam appeared with a sign that said "Keychain this sign is for you" haha... Martin and Sam call me keychain cause I'm so small I could "fit on a keychain." I didn't see Katie sadly, but I found out later that she was hiding next to the boys.
My friends are amazing... they totally made my day :)

When I hit mile 9, my feet started going numb and my legs were getting sore, still I kept pushing through and by the time I crossed mile 12, tears began filling my eyes...

I hit the last leg of the race and as the crowd's cheering got louder and louder I felt so completely overwhelmed with joy and gratitude. I was so proud of myself. I had become that girl... you know... one who actually cares about herself... one who holds her head up high... one who believes in herself enough to sign up for a half marathon and actually finishes it 30 minutes before her estimated time!

I crossed the finish line and I cried... I cried glorious tears of joy... because I have overcome so much
and now running a half marathon was another thing I could add to that list.

 I did it!

Friday, October 1, 2010

Magnet Conference

This week I was sent by my nurse manager to attend a conference through our hospital. The conference was about our journey in becoming a magnet accredited hospital. Magnet accreditation is specific to nursing and was originally created to prevent nursing shortages and increase retention rates for nursing in hospitals. If a health care organization is magnet accredited it signifies that the facility has better patient outcomes and exemplary nursing care.

In short if it is magnet certified... you want to work there and you want to get care there.

It was a two day conference with a ton of information that I'm still processing through. Unfortunately, I left with more questions than answers and in many ways felt like it was management's "Hoo rah!" as opposed to a championing of staff nurses becoming involved in this process. (The whole premise of the magnet system is about self governance, higher autonomy and a decentralized organizational structure.)

At any rate, I'm exhausted and to top it all off I had to switch my sleep schedule to go to it (us night shift folks don't like getting up early... it's why we work nights) and now its 4am and I have to work a 12 hour day shift today.     *sigh*

Oh well. When things become exhausting I just take a look at these and I close my eyes and picture myself here 

or maybe here
and life seems a little bit better... quieter after that.

Happy Friday Friends! The weekend is almost here!