Friday, February 25, 2011

I'm Back!

Marhaba! (Hello in Arabic)
Well.... I'm sort of back. I am home from vacation. It's good to be home and have my own bed and familiar surroundings and of course it was wonderful to see Chris after two long weeks of distance. It was great to see my bff Kelly and her husband J too. Still, coming back to reality and jumping right into the stressful world of the ICU has been a bit of a bummer. Mix that in with some serious jet lag and a bit of reverse culture shock... I'm still trying to get my feet on solid ground... if you will.

I have a million posts that I want to do about my time in Ireland and Lebanon.... I took close to 3,000 pictures! Yikes... gonna have to narrow those down and do some editing before I post any of them. :)
Ireland was amazingly beautiful but Lebanon captured my heart in a way that made me feel alive and so incredibly blessed. Something I haven't really felt in years. I can't wait to share more with you all.... but in the meantime I need to unpack, buy some groceries cause I have NO food in my house, find time to catch up on blog reading and settle back into the hum drum of daily life. Oh... and spend some quality time with the people I haven't seen in weeks.

So even though I'm back it will be a bit before I have some quality time for posts.

Hopefully... the pictures will be worth the wait :)

In the meantime, hang in there with me and tell me what life has been like for you these past two weeks... anything exciting going on in your lives?!

Monday, February 14, 2011

Happy Valentine's Day!

From Dublin, Ireland I wish you a very Happy Valentine's Day! I must admit that I have never really loved this holiday... Minus maybe when I was really little and got valentine's day cards from my classmates and a ton of candy to take home. Now it just feels like an oversold, commercialized holiday. At any rate, my Valentine is thousands of miles away so I am adopting my BFF Christine as my Valentine for the day. :)

We have a knack for being incredibly awkward and silly when we're together as you can see.

I feel incredibly lucky this Valentine's day because I have the greatest friends and family in the world. I feel incredibly loved by each and every one of them... But this time in particular I am not only surrounded by the love of friends and family but I am blessed enough to have a boyfriend that is so kind and loving and considerate. I have someone that has fought for me in ways that no one has and sees me... I mean really sees me and still continues to love me just the same. I can only hope he knows just how much he is loved today too.... Thousands of miles away or not. :)

Today I wish you all a wonderful day and I hope that no matter where you are or who you are with... I pray that you feel loved and cared for and blessed beyond belief. I hope you are surrounded with friends, family, significant people in your life that can tell you just how valuable you are.

Happy Valentine's Day Friends! <3

Saturday, February 12, 2011

Sneak Peek... our day in Northern Ireland.

The Shore at Giant's Causeway in Northen Ireland.
The Giant's Causeway- natural step stones.

The green meets the shore... only in Ireland.
Morning Sun in Ireland.
Ireland has stolen my heart in more ways than one. The people, the land... the accents! (which are so easy to pick up btw.) The Guiness! yumm
I took 1,500 pictures in the first day and a half alone. Just thought I'd share a bit of the beauty with you all. A glimpse of the unedited version of Northern Ireland.
Hope you are all having as a wonderful a Saturday as I am. If that is even possible... ;)

Thursday, February 10, 2011

Off we go!

Hello from London!
Currently I'm sitting in heathrow airport after a loooooong 11 hour flight and a somewhat frightening experience with UK customs. Seriously, the customs agent almost made me cry! Almost didn't let me into the country because i didn't have a printed itinerary and didn't know the full address of my friend's flat in Dublin. Ugh I hate traveling. I love seeing other countries but traveling is seriously the worst. Yet alas... I have made it through the first flight and in a few hours i will have my feet on Irish ground!
I will be in ireland for a few days visiting a friend who is studying in Dublin and then i will be headed off to Lebanon to visit another BFF who teaches in Beirut!
For now, I wanted to take this short layover as an opportunity to give a quick recap of my recent running endeavors!
My roommate Sam decided in the beginning of January that he was going to do a 50 mile run to promote cancer awareness. Being a cancer survivor himself it was an incredibly emotional event. I was lucky enough to run a few miles with him. Below are pictures of the crew heading off from one of the check in points along the way and pictures of me with Sam and a few of the
other folks who ran all or parts of the run with him.

Truly an inspiring day!
This past sunday i ran my second half marathon! I ran the kaiser half in San Francisco and it was great. I got a personal record of 2:25:15 and that even included exceptionally warm weather for SF and all of my walk breaks! I was thrilled and also relieved to be done with it. Seriously, running has become quite a serious thing for me as you can see from the picture below. The gear i need for one race is somewhat daunting. Garmin, gu gels, water, phone, racing pants and skirt.... The list goes on. I love it though and i hope i get a chance to do some running while I'm out of the country.

On the way home Chris and his little sister and i drove home on highway 1 along the coast. Here are some of the pictures i took from the car. It was great having them both at the race and having their support and then driving home on such a gorgeous road just made the day even better.
Well i must get on board my flight to Dublin. Hopefully I will be able to blog while I'm there but if not... You all better believe there will be some great pictures to come soon!

Wednesday, February 2, 2011

The difference between a great and not-so-great doctor from a nursing perspective.

Today I'm reflecting on what it is that differentiates a great physician from a not-so-great one from a nursing perspective. Working in a teaching hospital you deal with all types of MD's. Interns, residents, fellows, attendings... starting in that order from lowest to highest on the hierarchy... we get them all. Working night shift in the ICU we also have an on-call team that is here 24-7. Depending on what the night is like we will always have at least an intern and a resident on the premises. If the night is nutty and we have a lot of admissions or very unstable patients, the ICU fellow will usually stick around throughout the night as well.

It's been a while since I've dealt with a difficult intern or resident... to be honest the teams that have been rotating through have been really great and the doctors have worked along aside the nursing staff so well, which I'm so thankful for. Tonight though, I came head to head with a resident and intern that reminded me just how frustrating it can be to have a not-so-great team. At the moment, all the nurses on the unit are counting down the days until this rotation is over... kind of unfortunate really.

Now before I go into my rant about all the things that make a not-so-great MD I will say this... I get that there are not-so-great nurses too. I also get that during your residency you are sifted through so many places and units and services... each with their own set of protocols and "this is how we do it around here" politics and junk. The culture of every hospital and even every unit can be so incredibly different. I can see how it would be really tough and exhausting to adjust and learn in so many different places.

I know that all of the doctors I work with have dealt with probably some really not-so-great nurses and I assume that can make you a little leery of trusting or working on a peer level with other nurses in the future...


I feel there are a few suggestions for future MD's or MD's in their residency that will get you some brownie points with the nurses you work with.
1. I've said this before but humility will get you far. Coming into a unit that you've worked in for a mere two weeks and talking to a nurse who has worked there for 30 years with a condescending tone... not a good idea. Having a superior attitude and an "I'm the doctor so you WILL follow my orders" air about you.... not a great idea either. In fact its a terrible idea. With the exception of a few, most of the nurses I have worked with are very intelligent and I think people underestimate just how much we have to know as nurses. We know how things work in our unit. We know what the attendings usually want and what the surgeons prefer with their patients. We have a knowledge of physiology and disease processes and medications that is probably more than most medical students and interns expect. A little respect and trust is all I'm asking for here... and that takes humility from both sides of the fence.

2. Learn how to communicate. I think 1 and 2 go hand in hand here. In order to communicate well it takes humility. What I have noticed is that most of the time when someone is over confident and condescending towards others its because they are insecure and are over-compensating by having a massive power trip. Or maybe you're just a jerk... still.. learning how to communicate on a professional level with your colleagues and patients is key.

3. Teachability...
Huge! Ok... I know you are a doctor and I know you had to do massive amounts of schooling to become a doctor. I'm giving you the benefit of the doubt that you are brilliantly smart and motivated and hard working... I mean you made it through med school, passed your boards and you are in a very prestigous residency... thats all fine and dandy but you are not God and you do not know everything. I don't either... trust me... I deeeeefinitely don't. Still, most of the nurses I work with have years and years and years of clinical experience that any physician can draw off of. If we can't teach other and work with each other's strengths and weaknesses we are gonna get no where fast. And let me tell you... if you treat a nurse like he or she is beneath you and doesn't know anything and you know everything... you will make an enemy... Guar-OWN-teed... as gradydoctor puts it. :)
Ok basically just be respectful, humble and learn to listen to those around you... those three things go a long way in the nursing world.

Example for you all:
When I came into work tonight, I found out I had the post-op heart surgery patient and I was ecstatic... until... he began dropping his blood pressure and started shivering like mad... flopping in the bed like a fish out of water. His peak pressures were increasing on the ventilator, he was clamping down on his ET tube and he was fighting the vent like there was no tomorrow. All really not good things... things that could cause this guy to seriously crash on us if we don't treat it ASAP. So...I hunt down my resident and intern and I ask for some demerol to stop the tremors (usually caused as a reaction to anesthesia) and help sedate the patient so he wouldnt fight the ventilator and bottom out his pressures by "clamping down."

Their response?

"Just go up on the neo (med that helps increase blood pressure) and increase the sedation."

"Ok well he is already on 5 of versed and 500 of fentanyl and thats maxed out and its still happening. Plus CT surgery doesn't like us using neo on their patients because of the vasoconstriction and I wouldn't feel comfortable titrating up unless we got the okay from the CT fellow. I think if we gave him demerol he would stop fighting the vent. I could always give him some fluid too. His CVP is only 10 and CT usually likes it around 12 at least."

"No. Give the sedation more time to set in and just go up on the neo." the resident stands with his back towards me, arms crossed and continues his conversation with the intern.

Awesome. Apparently I don't even deserve to be looked at while you bark orders at me and refuse to listen to basically anything I just said.

You all can probably guess what the night was starting to look like for me. It was only an hour into my shift and I was already irritated. Luckily the ICU fellow came by at the time so I pulled him into my room and showed him what was going on. The intern and resident see him at the bedside and rush into the room to see why I was talking to the fellow and not them. I'm sure they could see that I was clearly frustrated at this point and I was about to go above their heads to get what I wanted.

All it took was a few seconds for the fellow to look at the patient and say, "How about I give you some demerol? Do you think 50mg IV is ok?"

"Perfect! Thats all I wanted!" I throw my hands up in the air and head towards our med station.

"And in the meantime let's give him a 500cc bolus of LR for his pressures."

What a sigh of relief! All I could think was, "Thank goodness for the fellow and thank goodness for doctors that actually listen to the nurses and don't treat us like we are completely inept!"

The rest of the night I had respiratory therapists and nurses coming in and out of my room to rant about how frustrating it was working with this on-call team and this particular rotation of docs.  The rest of the shift ended up being fine for me but it got me thinking about the way you present yourself to people and the way you communicate and how it can completely change a team dynamic. Also it can just simply make your life miserable when you alienate the very people who are helping you and it's so unnecessary.

Now if you really want a good laugh... see the list of ways to make your life completely miserable in the hospital, on gradydoctor's post here. I was dying of laughter the entire time I was reading it.