Veteran's Day

Last week I had a patient who was in the air force and was deployed to Vietnam during the war. He couldn't sleep that night in the hospital so we sat and talked for hours about life and the military and his experience overseas. He told me a story of a day when he wasn't feeling well and had to skip on a mission with the six guys he had been with the entire time he was in Vietnam. He was older when he went into the war and so he kind of took these guys under his wings over there. He loved 'em like family he said and when he woke up the next morning he discovered that the plane had crashed and every single one of them had been killed. To this day he wakes up with nightmares or dreams about them and he told me that every day he lives with guilt for not being with them on that plane. 

Today, I met up with a girl I happened to meet on a "what to expect" forum where expectant moms meet up online to share due dates and pregnancy joys and woes along this crazy journey. She happened to mention that she lived in my town and had just moved here cause her husband was stationed here with the navy for the next few years. We exchanged info and we had coffee today and walked around downtown. Her husband is currently gone for six weeks and she told me about all the moves they've had to make and the times he was gone for six months twice. How she is away from family and the support system she had built in their last base. I can't imagine. Sometimes we forget that the families of our soldiers have sacrificed so much too.

Life at the VA has been hard for me these past few years and I've actually been on the hunt for another job. Deciding whether I should leave or not has kept me up at night and has been the source of so much stress for me lately. I'm under appreciated and under paid where I work... my job is always exhausting and hard. The moments where I feel like I actually get to connect with these guys is rare and if I am really honest I feel like a lot of the work I do in the ICU is futile... often times these guys wait so long to get help that the chances of getting better are truly bleak. It's disheartening to say the least. 

Still, there is this place deep in me that continues to tug at my heart strings. I was telling my FIL yesterday about a new job opportunity and asking for advice on what to do. When I was explaining to him why I had always loved the VA I felt that familiar lump in my throat start to well up. What our soldiers do is incredibly difficult and what we offer is so very special. A place to be understood. A place where you can share about your time in Vietnam... and an ear to listen from someone who really knows just how PTSD impacts the lives of our service men and women. Some of these guys (and gals) haven't shared some of these stories with their own family even... and yet here I am at 2am hearing the heart of a man so burdened with guilt and sorrow over the loss he experienced decades ago. It is special indeed and I feel so very honored to be the recipient of that kind of trust... and a vessel for healing not only physically but emotionally too. 

I don't know where I will end up in the future but for now I want to thank you. Those of you who have given so much of yourself and the families who have sacrificed just the same. Thank you for being brave for us. Thank you for your sacrifice. Thank you for giving me the opportunity to serve you. If you know a veteran please thank them today... or tomorrow... or the day after that. Their sacrifice never really ends and I hope that our thanks never does as well. 

Happy Veteran's Day

Black Hawk Down

I have been a nurse at a Veterans Hospital for almost four years now. It is hard to believe that it has been that long. I haven't hesitated to say, especially lately, that this job of mine is not an easy one. Most of the time the difficult moments seem to out weigh the rewards. Still, every time I think about leaving this place I hesitate, and there is this scared, sinking, feeling in my stomach that tells me not to go. This overwhelming sense that this is where I am supposed to be right now. 

Last night, Chris and I watched Black Hawk Down and there was this moment at the end where Eric Bana's character says,

"When I get home and people ask me,'Hey, Hoot, why do you do it, man? What are you? Some kind of war junkie? I won't say a goddamn word. Why? They won't understand. They won't understand why we do it. They won't understand that it's about the men next to you. And that's it. That's all it is."

That hit home for me. I have said that so many times when I talk about our vets. The patients that I take care of are often a messed up lot. They have substance abuse problems, estranged families and multiple diseases as a result of self neglect and risky behavior. Of course some don't, there are some who are amazingly healthy and well adjusted, but sadly those are rare occurrences. Especially now that we are heading into the Vietnam war era of patients. PTSD is a given and many of these guys have some horrible experiences that no one else would understand but the guy in the room next to them. 

One patient told me a while back that he didn't even know what the Vietnam war was really about until a few years ago. His job was to retrieve dead soldiers out of the brush after major battles had occurred. That same guy also had newly diagnosed paranoid schizophrenia that was so bad he later threatened me and told me I was trying to kill him by inserting poison into the air filtration system. 

That was a relatively good day on the job ...just to give you an idea of what I mean by difficult. 

My job is exhausting ...and it wears you down ...and makes you feel powerless a lot.

But when I see movies like Black Hawk Down ...and when I see the 25 year old with half of his skull removed from an IED blast ...that is when I remember why I do this job. I don't always love it but I am always proud of it ...I am proud to fight for the soldier who fought so bravely for the guy next to him. 
I sacrifice a lot of sanity and a lot of myself for this job but I wouldn't have it any other way right now. 
Right now, I am proud to be a VA nurse.

ICU Nursing 4 years in...

For a while now I have been thinking about why I have such a difficult time blogging about nursing these days. I think it is a collection of things but the main one is mostly just because I have nothing to share anymore. When I first started this blog I found excitement in everything I did. I enjoyed finding the shareable moments in every experience... good or bad. Being a new nurse meant that every task was a challenge and it was fun to share it with others. I also loved the moments where I felt the reward of nursing... the tangible patient care moments that "made it all worth it."

I think if I am honest with myself, I would say that those moments are rare now. The work is still difficult but in a different way. It isn't challenging anymore... just hard. Long hours, night shifts and a messy sleeping schedule. The politics of a failed economy and its impact on a government hospital inevitably mean that budget cuts create a not-so-great work environment. All of that to say that I guess considering everything, I have not much of a desire to come to this space of mine to write about my job. Because to be honest that is all it is right now... a job.

Not to say that I don't have aspects of it that I still appreciate and maybe even love... but for the most part I have to pray to God multiple times a shift to remind me of why I wanted to be here in the first place. The good thing is that I am making some efforts to open up other doors in the future. I am chugging away at school so I can get my BSN and eventually my MSN (not sure in what yet). And truthfully I think things are in a good place because I don't hate my job like I did a few months ago. I think I am just beginning to consider the possibilities outside of the ICU. So we shall see...

Rough Day

Today is one of those days where I wish I wasn't a nurse. I dream of having a job where life and death is not on the table. Where the pressure to be perfect and always "on" isn't quite so strong. Where family members aren't skeptical of you right off the bat. Where doctors talk to you like you are a human being and not a servant. There wasn't any one thing that happened that caused this horrible day... it was busy and crazy and exhausting as always. 

Today it felt hopeless though.... I felt hopeless. As in "what's the point?" hopeless. Two patients with metastatic CA that I am poking and prodding and watching everyone freak out about when really they should be on a morphine drip in the hospice unit.

I don't know what it was about today but I felt like a failure walking out of that ICU. Like I messed it all up... and honestly I think it is because I don't agree with what I do half the time I'm at work. Forcing procedures on patients who do not want heroic measures.... it just doesn't settle right with me. Nursing today is getting harder and harder. More responsibility, more expectation.... so much pressure and stress to never make a mistake. And for what? For a patient who is going to die in a matter of months... weeks or days even. We do all of this for what? Is it for the patient or for our own peace of mind?

In the end we all have to go at some point... at the very least we can go in as little pain as possible and with a bit of dignity left. A choice in it all. I never understood why people would want to become hospice nurses but now... now I get it. I have a feeling I might end up down that path someday myself. 

Right now, all I can do is go to sleep and hope that God will give me the grace to be an ICU nurse for a little bit longer. 

The difference between then and now.

When I tell people I am a nurse... especially a nurse in the ICU, it seems as if most have a similar response. A sort of reverence and respect for those of us who dare to work in the business of healing the sick and dying. There is this impression that life in the ICU is thrilling, tough and exciting. You remember that one episode of ER you watched when it seemed like everyone in County General was coding left and right, meanwhile Dr. Greene and Dr. Weaver are saving lives like no one's business and you think... 

"All hospitals must be like that! How exciting!"

  Smarter folks would run for the hills... 

but I digress.

During nursing school and as a new grad I had what they called a "road kill mentality". Anything and everything gruesome and/or extremely unstable was an adrenaline rush... a challenge... a thrill to be sought after. The tougher the assignment the better. It made me proud of what I did. Every opportunity... whether it be putting in a simple IV or assisting with a bedside insertion of an intra-aortic balloon pump... it all was exciting to me and the sicker the patient... the more fun it was. I couldn't wait to sink my teeth in more. To learn and grow. To become a nurse that people revered and respected. A nurse that people came to because I knew my stuff.

But that is not the majority of nursing. The moments of thrill and adrenaline are few and far between and if you are seasoned enough those very moments are moments of stress and sometimes fear. You realize you are the one fighting for someone's life and suddenly this patient in the bed is not a lesson or chance to grow anymore... it is a life.

Nursing is not made up of those action packed moments filled with the rush of saving people. The heart of nursing is centered around patient care. Patient care that includes bed baths and cleaning up things you normally wouldn't touch with a ten foot pole. Nursing is made up of people who are sick and at their worst. People who are often times ungrateful and mean. Family members who are frustrated and defensive.
Nursing is made up of the little things that add up to something big. Oral care on a patient that has been intubated for weeks and has a mouth that smells like a sewer. Nursing is taking care of patients who don't even take care of themselves. Answering to a patient who yells at you and to doctors who don't care to learn your name. Nursing is destroying your back while getting a 300lb patient out of bed with a lift all the while trying to manage IV lines, a ventilator, a foley catheter and a chest tube. Not to mention doing all of these things without help because no one has the time or budget to give us the resources we truly need. Nursing is servitude. Nursing, my friends... is not an easy or glamorous job... it is not always fun and often times it is thankless.

The difference between then and now is learning that the "tougher" assignments are not the ones with the unstable patients that have interesting procedures but the ones that are filled with hundreds of menial tasks that leave you emotionally drained and physically exhausted at the end of the day.
The difference between then and now is the reality that sometimes our callings in life are not exciting or thrilling. Sometimes we are not called to mission fields far off in the middle east or deep in the heart of Africa. Sometimes we are called to serve the least and the last right in our own backyards.
The difference between then and now is learning to love the parts of nursing that are not so glamorous, because at the end of the day that is the heart of what we do. It is the heart of what I do.
We heal the sick and the dying. And for that... I can be proud.

Nursing Today

Last week one of my co-workers retired and upon his leaving he left all of us on the unit a letter. People had been frequently asking him how he felt about retiring and the letter was his response to that question.

He explained that for him, nursing had changed. "Nursing," he said "is an aggravating job." It seems as if every day there is more work to be done. More people to look over your shoulder, telling you how to do your job. Dictating what you do and when you do it. More rules and regulations to follow and less time to get it all done in a day. Our patients are sicker these days. Technology has advanced and yet the things that are supposed to help us often don't as they should.

The team work and the people will be missed... the chance to be apart of the world of nursing and it's advances in healthcare will be missed too. The back breaking nature of the job and the complete and utter exhaustion at the end of every shift will not. The lack of resources and help when we need it will not be missed either. Taking care of ICU patients and seeing them recover and the gratitude they have will be difficult to leave.

There will be a large void left with retiring from the nursing profession but as that door closes another shall open. The possibilities are endless.

"To put it simply," he said "excited would be a good word for how I feel."

It was so poignant and concise. There was no hesitation in getting straight to it. Nursing is a difficult, frustrating and yes... at times an aggravating job. There are some amazing, rewarding parts of the profession and we are lucky to work with a great group of people.... but when you get to a point when you go home every day worn to the bone and your days off are devoted to recovery... that's when you know it is time to go.

As I sat and read his letter... over and over.... the entire time I kept thinking, "That is exactly how I feel about this job." It was heartbreaking in some ways. To realize that I have come to a point in such a short amount of time where leaving the profession sounds like such a relief.

My health has not been great over the past few months. I have found myself feeling recluse and tired and empty lately when it comes to nursing. There have been moments where I have loved my job and moments where I think, "Now this is why I am a nurse." Yet, overall I feel like I don't have much left to give people... and that includes friends and family which is why it feels so defeating. We have very little support from management and often times I just tend to avoid them at all costs.

Life has been busy too and because I have a night shift schedule I don't ever feel like I have a normal life... or a normal marriage which can be hard. It wears you down sometimes and I don't think it is something that people understand easily.... nor do they have empathy for it.
So... for now I have been praying about it and looking at other options. I don't plan on leaving nursing but it makes me wonder if staying in the ICU will be for me. Who knows? The one thing I can say though is that the world of nursing is large and I know that no matter what I do... I will have many doors to choose from. It's just a matter of having the courage to open one of them. 

It ain't about me... or is it?

Warning: I'm about to get brutally honest here so hang in there with me... this won't be one of those mushy "nursing is so great!" posts.... cause truth be told, nursing has not been so great recently. In fact it's been tedious at best. I have not been at my best recently either. I'm tired and to be honest I'm a little bored these days. I find myself counting down the minutes until my shifts are over and my fuse has grown short with people.
I have to say that there are a lot of times in my job when I take things personally even though I have no business doin' so. In my line of work you deal with people at their worst. Sick, broken and teetering on the edge of life and death.
For some reason, recently people have been straight up crazy though. Like kickin', hollerin' and bein' down right mean -crazy. Most of me gets it. I get that when you are at your worst you don't have much to give, especially if you really aren't in your right mind... which happens a lot in these parts. There is a reason ICU delirium is a legit diagnosis.
Most of the time I'd like to think that I handle these situations okay. I see what happens when people get defensive and try to argue instead of understanding. It just doesn't work and usually it just makes the patient angry and you more frustrated. If I was in that hospital bed who knows how I would be? Just take a look at me around 4:00am on any given night shift and you'd probably have a slight clue.
Lately I have been in this weird place. Apathetic in a sort of way to what goes on around me. You see sickness and death all of the time so when a patient comes in with cancer that has ravaged their face you aren't moved the way you once were. Or when a patient with severe pulmonary disease is throwing the biggest fit in the world because they have to be on an obnoxious bipap mask all night... you tend to not have as much sympathy as you once did.
No... now I find myself annoyed at every call light I have to answer. Tired of the same old routine that doesn't challenge my brain but injures my back and zaps every ounce of energy I have left. Frustrated because I can't understand what my patient is trying to say... it's difficult when you've had half your tongue removed, ya know? That is not what crosses my mind though... the fact that he is angrily pointing at these scribbled, jumbled letters on a piece of paper like I am supposed to magically understand them... that is what I see. Frustration and pain and exhaustion... from both parties.
Finally I discern what he is trying to convey...

"It hurts when I swallow... is that ok?"

"Yes, that's totally normal." I nod my head eagerly. 

Relieved to finally be able to communicate, the man breaks down in tears and starts profusely apologizing.
"I'm sorry. I'm so sorry." he mouths as he lays his head back on his pillow.
The floodgates have now opened and I instantly feel like a horrible person.
He knew I was getting frustrated too and I probably could have done a lot more to hide that fact. To have patience and understanding for a man who is battling the big C and now has a very long and brutal recovery ahead. Today I will go home and I will crawl into bed a healthy person... sleeping in my own house peacefully.
This man will not.
He will not have anything close to that and the least I could have done was given him a little room to be frustrated without me being annoyed or inconvenienced back.

I told him that he did not have to ever apologize to me for something like that. I held his hand and told him that I was sorry too.

The worst part of it all is that I don't really know what to do from here. I come to work every day. I do my job as best I can but I'm realizing that my best sometimes just isn't what it should be. I am tired... all the time. I am bored with my job and don't feel challenged but I have no desire to change. I am holding it together on the surface just fine but inside I feel like something just isn't right. And I can't help but wonder if the problem is everything else or if it starts right here... with me.

Nursing Burnout and Divine Appointments

 It is not a secret that my job has been difficult lately. So much so, that I have not felt a desire to talk about it on here much... at all. Summer time in a teaching hospital is difficult and even some of our most positive, peppy nurses have been sucked dry of energy, to the brink of burn out.

I have felt myself on the verge of it also. If I remember correctly and thankfully to the documentation of this blog.... this happened last year also. The difference is that this year my life is much more busy and hectic... but I am also a year more experienced.... so now I know when to say something and when I can just let it go.


I have a new love and respect for our medical students and I am thankful for those that have the zeal of someone who wants to help heal people and the humility of someone who knows they don't know it all. I wish our new interns and residents had the same mentality. It makes me sad when the physicians are at odds with the nursing staff. I promise we are not the enemy.... there is nothing more that I love than having a good relationship with our physicians. It makes my job so much easier and it makes everyone a lot happier. I can share my experiences and they can share their knowledge. That way everyone learns and everyone grows.... working cohesively for the better of the patient. Shouldn't that be the goal? Egos aside... the patient's safety and health is the most important thing, right?

There have been many times this past month that I have left work in tears. Exhausted and worn out. Taking care of people when they are sick and angry is difficult... especially when they take it out on you. You get opposition from all sides... the patient, the family, the doctors, the nurse execs. I have learned that sometimes the only allies you have are your co-workers.... yet, even they can fail you at times. I know I have failed a lot.


The other day a co-worker of mine overheard me explaining why I did not want to work an overtime shift and she said, "Well, you're ahead of schedule!" When I asked what she meant she explained that she was referring to the fact that the average dropout rate for new grad RN's is three years.


3 years is how long most new grad nurses last in this field. By year 2 of their career 57% of new grads will have left their job due to negative workplace conditions. *source Those aren't good odds but I have no desire nor do I have any plans to leave my job. I just simply don't want to work overtime.... hoping to preserve any love for nursing that I have left at the moment.


This past weekend I went to a BBQ with Chris' family and I ran into a random friend of theirs... an old neighbor and also a nurse for many years. This woman is now in her 80's, long retired but still very updated on nursing practice and technological advances in medicine. She has been a patient many times as well. I happened to mention something about my job and that led to about a 30 minute conversation about nursing and being a new grad and dealing with difficult physicians and the struggles of our line of work.


She told me that there were many days when she would go home in tears... so many times she had to stand up to the physicians who treated her disrespectfully even when they were in the wrong... and she told me about the time she was choked by a mentally ill patient and verbally and physically assaulted by many others. She reminded me how difficult it is to work 12 hour night shifts in the ICU. She told me that there are few careers like nursing that encompass so many sides of humanity and how there will be few people.... if any, who will truly understand what we deal with on a daily basis.


But best of all... she told me that I was not crazy... that the pain and the hurt and exhaustion I was feeling was normal and that it too would pass. She reminded me to take care of myself and take time away when it's needed. She encouraged me to lean into the relationships I have with my co-workers. She validated how I felt and affirmed that even though people don't understand how difficult it is... it does not mean that I am alone. She told me that the day I stop feeling so deeply and passionately about my job... is the day that I need to step away... but that I am not there yet.



It was a divine appointment. It was exactly the thing I needed to hear and it gave a voice to my fears and struggles and hurts. This 82 year old woman who did not even know my name gave me something that even the closest people in my life could not. Understanding... and relief.


For those of you out there experiencing burnout... whether on a scale large or small.... New grad or not.... you are not alone. And if at the very least... the next time you go to work and feel overwhelmed or exhausted or like you have nothing else to give.... know that you are not crazy. No, you are not crazy at all....

... and that this too shall pass. 

July

I despise the month of July. Truly there is nothing good about it. It is hot and the rainy season is long gone and still far, far away. There is way too much to do with no time to do it. We are always short staffed at work. It's impossible to sleep during the day. The hospital is inundated with gobs of new interns who have egos the size of Jupiter and an experience level the size of an ant. (ok maybe not all but most.)

Seriously. I hate the month of July more than I hate peas... or bacon... and let me tell you... that is saying a lot.  

I don't enjoy feeling this way. I don't enjoy that feeling of dread as I read the assignment list every day. There aren't any "good" assignments these days. The patients are either really sick or really crazy or really violent or really mean. I am thankful for my co-workers that keep me sane but even a few of the good ol' standby people have been in a bad funk too.... might have something to do with the fact that they have had to work literally 19 days in a row. 19 days. 12 hour shifts..... 19 days in a row. Yeah, I'd be grumpy too if I worked that much.

When your career is one that involves taking care of sick people it is easy to get tired and burnt out fast. Especially when the people you are taking care of are crazy and mean and unappreciative. I always think its funny... when people (usually the docs) say things like "oh don't take it personally they aren't in their normal state"

hmmm... ok well how about this.... how about I go take a nap in the on call room while you sit here and get spit on and called a whore and a stupid b*tch for the third day in a row and then tell me you aren't gonna be a little bit worn out after 3 days and 12 hours of that. Oh and btw good luck getting a break to go to the bathroom or a break to eat your dinner. Sound good to you?

I am thankful that I get to be an advocate for my patients and I am thankful that I have a job that I usually love... a lot. But sometimes.... just sometimes, I think... I know I am your advocate but who is mine? When you go home every day practically in tears from exhaustion and you know you have a month straight of an insane schedule with no time to re-charge.... it is daunting and it makes you wonder how in the heck you are gonna survive another week.

At this point I don't have any good answers...

Did I mention that I hate July?

7 Quick Takes Friday

1. I DID IT! Marathon #2 is in the books friends! It was much harder than San Diego in many ways. My time showed it as I was a 8 minutes slower in this race. Can we says hills, hills, and more hills?! Parts of the course we're beautiful though and I loved the cool weather of Seattle.

 

2. Had a complete and utter melt down around mile 23 of the Seattle marathon and called my friend Tim to inform him that I would NOT be doing anymore marathons. He bet me ten bucks that in a few days or so I'd suck it up and decide to do the final marathon in SF on July 31st. "I feel like you're just intense like that Andi" haha thanks Tim... and he was right btw. I'm still planning on doing the SF marathon. This time I'll be doing some serious hill training before.... that includes a somewhat hilly half marathon race this weekend. Yay for having two marathons under my belt though! Isn't my medal pretty?

3. These past two months have been insane... between marathons and work and life in general I haven't had much time do anything... let alone blog. Today though has been good and I feel like for the first time in a really really long time I am pretty much caught up on stuff. I even spent the day editing Seattle photos... (all of which I love!) I will do a whole other post of them and the trip itself soon. :) sneak peek for now.

4. I have decided that July is officially the worst month in the ICU (at a teaching hospital). Mainly because everyone and their mom is on vacation = we are always short staffed. Also because medical school ends in June and residency starts up in July = folks who were medical students yesterday are now interns taking overnight call in the ICU the next. It's a scary time people... makes a nurse's job a lot more difficult when you deal with doctors who don't know anything but think they know everything. Luckily they aren't all like that but I have already had my fair share of run ins with people gettin' crazy. Post soon to come: How to survive July in a teaching hospital. haha

5. This week Chris had surgery. Somewhat an emergent one too. He's okay thank goodness but he tore the meniscus in his knee and hasn't been able to walk since Sunday. So that means this week has been full of doctor's visits, MRI scans, surgery and recovery time. I have been nurse at home and nurse at work. Truly "on call RN" is so fitting. I love being able to offer help and comfort in that way though. Now its just 3 weeks on crutches and a bit of physical therapy and he should be good as new.

6. Had my annual performance review at work this week and it went really well! Yay for that. My manager wants me to take the charge nurse class this fall and she also wants me to start precepting nursing students. I'm willing to try it... even though I honestly don't think I'd be that good of a teacher. I try to be an encouraging person but I know I am also crazily Type-A and I have a tendency to be a micro-manager/control freak. Don't know how well those two things will go together. I guess stay tuned and we shall find out? haha

7. Happy belated 4th of July to my American readers! I spent it at work again. (dumb dumb here forgot to ask for it off even though it's one of my favorite holidays) Did anyone get to see any great fireworks? Even though I was stuck at work, I was thankful to be serving our veteran's on a day that celebrates our nation's freedom. One of my favorite photos from Seattle... part of the war memorial garden in downtown. 

Incredibly moving.

Have a good weekend friends!! Anyone have anything fun planned?

Remembering to breathe today...

18 days ago I ran my first official marathon. It was hard. It felt like it would never end. I finished it but I didn't fully enjoy the triumph because I knew I would have to do it two more times in the next month or so. Marathon training has been one of the most exhausting and stressful things I have ever done. I am still not totally sure that it was worth signing up for three of them so close together. 

This week has been brutal too. In nearly every area of my life there has been a break down and it has been stressful and emotionally exhausting. I can't think of one thing that was reliably comforting this week. Lots of drama and hurt and stress. I feel drained and empty and like I have nothing left to give. Absolutely nothing. If it were up to me I would lock myself in my room and hide under the covers for the next three days just to recuperate from this week.  That's how bad it was. 

Instead I will be flying to Seattle tomorrow to run my second marathon. It will be a three day weekend full of traveling and expos and lots and lots of running. This will be such a different experience than the San Diego marathon. This time I will be alone. No one will be traveling with me. No one will be meeting me at mile 5 with a sign or running with me at mile 11. No one will be there at mile 25 when I fall apart and feel like I can't take another step. There will be no fanfare at the end after I hobble my way through the finish and reach the other side with a medal around my neck. There will be no one but me and my own two feet.

I'm glad it will be in Seattle because I absolutely love that city. I am looking forward to the weather and the change of scenery and if I'm really honest... part of me is really looking forward to the solitude. My introverted self is screaming to have some time to rest (sad that at this point I consider running a marathon rest). I really don't feel like I have anything to offer anyone at the moment and if I were home I think I'd just fall apart from the fatigue of it all. At least this way I can do nothing but focus on running and surviving the 26.2 miles of pavement I have waiting for me.

My schedule is pretty full and I still haven't figured out the logistics of how I will get around the city once I arrive... I guess we'll just see how it goes when I get there. I do hope to get a chance to go back to Pike's Place and take some photos and walk through the market again at the very least.

It is going to be a tough weekend but for the first time this week the toughness is for me. It has nothing to do with anyone else and their demands or shortcomings or misunderstandings. Nothing to do with work or relationships or friendships or family. It simply has everything to do with reaching down deep and finding the strength to conquer a marathon... for no one but me. I am not doing this for anyone else but myself. Running has always been the one thing that no one could take from me.  It gave me joy and strength and hope and peace and a sense of so much pride in who I was.... in who I am. If I let this disastrous week stop me from remembering that and fighting for that... than I will have let everyone else dictate my ability to prove that I am worth the fight. The only way I know how to fix that is to run and to run far. If I am successful it will either destroy me or it will be just the medicine I need to feel revived again.

I guess we will find out when I cross that finish line...

7 Quick Takes Friday... a little late

1. There are certain shows that just make me happy. I don't know what it is but there is just something completely comforting about them. What's funny about it though, is that they are really random ones... Just a few I can think of... Gilmore Girls, Friday Night Lights, Drop Dead Diva (a lifetime tv show... I can't believe I'm admitting I watch that) Deadliest Catch... I have no explanation but on nights when I am up late and suffering from insomnia and the rest of the world is peacefully resting and I feel completely mad cause I can't sleep... these shows give me comfort. Yay for the little things.

2. Speaking of the little things. My BFF Kelly found this awesome tumblr that totally made my day.

One of my faves: #357. Changing into sweatpants. SO true.... one of the best feelings ever. Especially if you've been dressed up all day! Check it out. I'm sure it will make you smile. :)

http://justlittlethings.tumblr.com/

3. The interns and residents at work crack me up sometimes. I can't tell you how many places I have found lines of surgical sutures attached to things. The most recent one was a phone cord. lol Obviously a teaching moment. Other fun places I've had to cut practice sutures from... chairs, blankets... the list goes on. Good times.

4. I recently started going to the Chiropractor and it has been time consuming (3 times a week I have to go for now) but it has been helping! I've been noticing some funny issues with my running form and I pretty consistently have neck, shoulder and back pain so when I found a deal at a local art and wine festival (random!) I decided to sign up for a consultation. So far, so good. When I ran my SD marathon my usual back and knee pain didn't flare up until mile 20ish which is amazing.

5. Just to give you an idea of how completely jacked up my spine is. Here is a picture of my x-ray. Your neck is supposed to have a very clear C-shape to it, with the rounded part of the C going toward your jaw line. My neck is so out of whack that its S-shaped and is basically going the opposite way it's supposed to go. Not good times.

6. I recently finished reading the novel that Kelly wrote. I have read a few different revisions of the book and I have to say that this was hands down my favorite. I am a difficult reader to catch. I don't read novels very often mainly because I don't find many of them interesting enough to spend the time reading them.... but this book was amazing. I may be biased because she is one of my best friends but seriously it was good. So good that when it was over I felt a sense of loss because I became so attached to the characters. It was filled with such insight and depth and compassion. It was beautifully written and had me in tears at points. She recently acquired an agent and is in the process of finding an editor. I can't wait to go buy her book someday and turn to the person next to me in the store and say "The girl who wrote this is one of my best friends!" Truly amazing!

7. I am slightly on the verge of burn out. This week I work 6 days in a row and then I have one day off and then I come back for 3 more days, then I leave right after to go to Seattle to run my second marathon. I don't have enough time to do anything. Time to clean my house properly, time to go to church, time to sleep, time to run enough, time to stop and have some "me time", time to study for the CCRN exam, time to actually see my friends more than once a month. I feel like I've had this issue for a while now and I'm starting to sound like a broken record. Don't really know how to fix it because my schedule doesn't look like it will be changing for a while.... but something's gotta give or I'm gonna have a melt down. Anyone have any ideas?

a moment

today every part of my soul feels weary. i have been walking in a sort of daze. a mix of exhaustion and sorrow and gratitude. there are moments in your life that change you. moments that give you such a clear view of your existence that you can never be the same. i made the choice to become a nurse because i knew that if i did my life would never be the same. 

it has been a long month. a busy one in our unit and it has taken a visible toll on everyone. lots of sick calls. lots of complaining. lots of very sick people who need a lot of care and not enough people to give it. emotionally we have all been drained. i am drained too. 

in the past month i have taken care of multiple patients with debilitating, chronic, fatal diseases. they teach you in nursing school how to have boundaries. how to let go and care at the same time. how to set limits with chronic patients without seeming harsh. i have never been good with that. i oscillate between the lines.

yesterday was my last night of a long stretch at work. i was tired and in pain. i had a very stable assignment. not a busy one by any ICU standard. just difficult. one patient on his 7th round of chemotherapy, suffering from a vicious cancer and a mild infection. i was thankful he slept for almost the entire 12 hour shift. thankful for the chance he got to rest and restore but thankful for myself too. thankful for the minimal interaction needed. 

my other patient, a man in his prime, suffering from the end stages of ALS (lou gehrig's disease). the only muscles left with any sort of function in his body were above his neck. he could not move, could not eat, could not speak. he couldn't even breathe without the help of a ventilator and tracheostomy that was placed. he could barely mouth enough words to ask for what he needed. his wife was there at the beginning of my shift. she wanted to make sure the night shift nurse was a "good one." that is always a bit of an anxious thing for me. the ICU is stressful and often times families of ICU patients are burdened with fear and sadness and an acute awareness of their loss of control. then here comes this 26 year old girl who will be taking care of your husband, father, brother... your son, who is on a ventilator and a plethora of medications that need titrating and managing. for them it is terrifying. which i understand. i do. but it is still hard.

it is hard to tell what they expect. what they want. do they want you to be happy and positive and cheerful? do they want you to be serious and somber and just down to business? or do they want you to be friendly with them and treat them like you have known them for years? i see some of my co-workers who are warm and friendly and smiley. hugging their patient's family members and chatting like they are bff's. i have never been good with that. i am not good at being smiley. i am genuine and hard-working and compassionate but i am not smiley. when i am at work i am serious and professional. i think some people see it as being cold and that is difficult for me. i want them to know that i am giving 100% of my attention to their loved one but it is hard when you don't know how that person receives that message. everyone is different. 

often times i am the one who relates to the few that everyone else has a hard time with. the quirky, walled up, introverted ones. the ones that take a little more time to get to know. i get that because i am that way too. maybe it is a trust thing. or maybe its just time. i find though that the ones with the hardest shells have the softest hearts. a lesson my mother taught me years ago and one that i never forgot. 

i knew this could be a difficult night. i was right. it was difficult. it was long. it took every ounce of energy left in my being to give the care i gave. it took a lot of venting sessions in the break room and hugs from my co-workers too. i am so incredibly thankful for them. they keep what little sanity i have left intact. 

i spent 90% of my evening trying to understand my patient's pleas for help. imagine what it would be like to have your mind fully functioning and completely aware of your existence but to have no way to connect that to your physical body. imagine having no way to move into a comfortable position. no way to wipe the tears from your eyes when you are sad. no way to scratch your head when it itches. or move the covers off of your body when you get hot. no way to eat or no way to communicate clearly that you've gone to the bathroom in your bed and need to be cleaned up. no way to tell someone you love them. or to say that you are in pain.

every time we had to do anything to my patient it required a 30 minute session after of discussing ways to reposition him. he would nod and attempt to mouth words but it ended up looking like the mouth of a puppet on strings. everything jumbled together and nothing was comprehensible. i resorted to head nods and one word phrases. 

Is it your head? no

Is it your arm? no

Is it your shoulder? no

Is it your hand? yes

Okay!

Is it too low? no

Is it too high? no

Is it your fingers? yes

Do you want me to spread your fingers apart? he smiles.

I fix his hands and he begins to nod his head towards his left and looks down at his hand.

Do you want me to fix your other hand too? no

Huh... try to mouth it to me.

Up? no

are you saying head? no

Im sorry but I can't understand. Try again.

I turn on the lights and walk around to the other side of the bed and begin again.

Is it your arm? no

Is it your leg? no...

I take a deep breathe in and proceed to look around for anything that looks uncomfortable.

30 minutes and 10 pillows later we have him propped up in a position that is comfortable.

an hour later the process repeats itself again.

by the end of the 12 hour shift i was translating to people what he was trying to say and dictating exactly where he wanted every limb of his body to be. down to every toe and finger... everything had its place. by the end of the 12 hour shift i had nothing left. i thought about his wife at that moment... and how she looked on the verge of tears when she left the night before. and how i thought that it was because she was sad that her husband was dying. and now i was wondering if it was also because a part of her was dying too. the life she once knew and the love she once had would never be the same. the dreams she had. the children they had. nothing would be the same. ever. and how she must feel so incredibly exhausted and drained after a year and a half long of this.

i wanted to weep for her. i wanted to tell her how sorry i was and how unfair it was and how i wished it were different. for both of them. i wished i could do more. make it easier some how.

i prayed at that moment that God would give her rest then. peace. that she would sleep well and heal too while her husband was being taken care of here. 

when i went into the room to say goodbye that morning he looked over at me and mouthed the words, "thank you. you're the best" and smiled so wide i could see the deep wrinkles form around his eyes.

i could feel the tears reach my eyelashes.
"no my friend, thank you" i squeezed his hand and smiled back.

there are moments in your life when you know that you will never be the same. and in that moment i knew that as i walked down the stairs to my car that morning, i would feel every step and inhale deeply every breath. that i would go home and tell the people in my life that i love them because i can. i also knew that this was one of those precious moments... a moment where i would surely never be the same.

10 things I've learned being an ICU nurse

In honor of my 100th post I figured I'd write 10 important things I've learned these past two years of ICU nursing. 10 things  I would tell myself as a new-grad... if only I knew then what I know now. I think it'll be fun to do this and see how it might change over the years.

10. When in doubt gown up!
Self explanatory really but if you're interested... Read this post and you'll see just what I mean. Also, since we are on the subject... it never hurts to have an extra pair of scrubs in your locker and this can be applicable to any hospital health care worker.

9. It's all in the details...
Even if its the smallest change or just barely off vital sign, lab value etc... sometimes its the subtleties that add up to a very important diagnosis. Example: A nurse once sent home a pediatric patient with a temperature that was slightly below normal. 96.9 f (normal  is 98.6 f) The child ended up back in the hospital the next day with full blown sepsis and ended up later passing away. The below normal temp. was a sign that the patient was in the "cold" phase of septic shock.

8. Some things just take time.
No matter how much you study or how many classes you attend...some things just come from experience.... and that just takes time. Don't stress about trying to get the "difficult" assignments... they will inevitably come to you and when they do... trust me... you'll miss the days of getting the patient up to the commode 10 times in one shift.

7. A little lot of humility goes a long way.
If there is one thing I've realized about myself and people in general while working in the ICU is that a lot of the time when people are cocky or defensive it is because they have some major insecurities they are trying to compensate for. Consciously having humility will always get you so much further than being domineering or prideful towards others... especially when you are working in a team setting.

6. Never, ever say things like, "I'm bored." "Man, it's slow." or "It sure is quiet around here these days!"
Phrases like that are certifiably going to buy you at least one nasty code blue or a few gnarly admissions in the middle of the night... if it's quiet just enjoy it while it lasts!

5. If you are unsure about something STOP and double check before you proceed.
Probably one of the hardest lessons I have learned since becoming an ICU nurse. Even if it is in the middle of a code... even if people are rushing you or yelling at you... even if you are afraid of looking dumb... if you feel unsure about a drug you are giving or a procedure or a protocol... stop and ask! Trust me... it is always worth taking the extra minute or so to double check or to ask for help. It takes only a few seconds to make a fatal mistake and only a few seconds more to prevent one from happening. It's always worth the extra time and people will trust you and respect you more if you know when to ask for help.

4. A good report sheet and a checklist can keep you sane.
The thing that I love most about ICU work is the detail of it all. As ICU nurses we care for our patients from head to toe. Most of the time our patients rely on us for everything large and small... from oral care to breathing. No task is insignificant and sometimes remembering it all... even if you have only 1 or 2 patients... can be daunting. Having a thorough report sheet and a checklist of things to be done can be a complete lifesaver when things get crazy.

3. Choose to be happy.
The ICU is often times a really difficult place to work and if you aren't intentional about being happy in the midst of that... sometimes it can really bring you down. I think sometimes we have to make a conscious effort to smile, laugh and be happy because usually... the people around us are really sick and scared and are often times in the worst physical state they have ever been in their entire lives... it never hurts to try and bring some joy into the ICU.

2. Leave work at work.
When I first started I used to always bring work, home with me. I think its only natural to do this to a certain extent but it has to be in moderation. It's a good thing to maybe re-hash your day on the drive home a bit... maybe there is something you forgot that you need to communicate to the nurse who followed you.... or maybe something went wrong and it's good to think about how to do it better next time. But seriously... learn to just let it go. Take a deep breathe, go for a run, read a book, take a hot bath... do something to re-center your mind or the stress of working in the ICU will have you on the burn out list before you can say "help!"

1. Follow your intuition!
Because most of the time you are completely right on and it may be that the "hunch" you have can be the clue that can save a person's life. I can guarantee that you will never regret bringing up the small things to the physician even if they seem silly... however if you ignore what your intuition is trying to tell you, and it means you miss something huge later on... well that will be something you will definitely regret.

The ebb and flow of ICU nursing

Halona Sunrise

It almost frightens me to say so (especially since as I write this I have one more 12 hour shift left tomorrow) but work has been good this week. *knock on wood* Any ICU nurse knows that you don't dare jinx things by saying something like "man, it's been quiet here today!"

The next thing you will hear is "CODE BLUE" blaring over the loud speakers. Still, I'm taking a risk and just acknowledging how thankful I am to be in an upswing at work. It's been steadily busy but not crazy and we have had a lot of good people on staff this week. No issues with the on call ICU docs (miracle I tell you) and in fact this month has been good so far. Last month was great also so we've really been on a roll with our ICU team. I also think it really makes a difference when you have good nursing staff on your side. I've been working with my favorite people recently which has been nice... and sometimes that one factor will determine whether it is a good or bad day.

Waimanalo

I was able to take a training class on CVVH or continuous veno-venous hemofiltration on Tuesday and I was resource yesterday which was nice. I've been getting back into my training schedule in terms of running. Unfortunately my running injury has begun to flare up. I'm biting the bullet and looking up some sports medicine doctors in my area who might be able to help out. Very important considering I have only a few weeks left before I run my first 1/2 marathon!!

Waimanalo

This past weekend I spent time editing photos and sort of winding down from a really draining two weeks. Before I left for Hawaii I had already been feeling like I needed some good down time by myself and it wasn't until this past week that I started getting that. Being as introverted as I am its so vital for me to have time to stop and reflect and process, because when I am around people... even people I love a lot... it takes a ton of energy and I don't ever really get to stop and feel refreshed from my crazy life.

Halona Sunrise

It's been just over a year now that I've been working as an ICU nurse and even in that short time I have seen the ebb and flow of this job wash over me. There are good days and bad and sometimes they may even turn into good and bad months. I remember my preceptor last year warning me about this.

"You will go through phases of burn out in your job... that is normal and eventually things will get better. You learn to adjust and you learn how to take care of yourself properly so you can function the best way possible... even in the midst of a burn out. When you are not able to shake out of that funk and when you begin compromising patient care... that's when you know it's time to move on."
Wise words that I have taken with me and remembered in the tough moments and have been thankful for when it feels like the bad days just won't end.

Waimea Bay

Today I am taking care of a patient who was placed on comfort care this afternoon. Other than cardiac patients, these are probably my favorite patients to have. I know it sounds strange to enjoy taking care of a dying patient, but there is something incredibly peaceful about death despite the sadness. There are few things in life more impacting than being able to be present when someone passes. To be able to give them dignity in dying and to be able to make every effort for their comfort in their last moments on this Earth... it is an honor and it is in these moments that I remember... this is what nursing is all about.

Halona Sunrise

P.S. I'm totally kicking myself now because I'm at work on that last 12 hour shift I was talking about... no joke... not 5 minutes into my shift we were coding a patient and it was a little bit of a nightmare... after an emergency intubation, CPR, 2 rounds of epi., 2 rounds of bicarb and 2 shocks from the defibrillator we finally got the guy back....
hah... I really gotta stop jinxing myself.

Oh the joys of ICU  nursing.....

 

Halona Sunrise

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? :)

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.

Patient advocate and so much more

If there is one thing I know about nursing it is that being a patient advocate is only the beginning of my job. This job has so many roles and because I work in critical care I think those roles are only expanded and magnified. Everything is intense...hence "Intensive Care."

In the process of feeling completely overwhelmed and burnt out, I had to step back and really evaluate a couple of things.... and the comments and responses I have gotten from people when I share where I am at as well. 

This month marked the end of my first year working as a full-fledged RN, and it has been quite a roller coaster, for sure. I think it is well known that in this profession, your first couple of years are the hardest and especially going straight into the ICU as a new grad, that inevitably throws a whole new mix of emotions and hurdles to overcome.

In the past month or so I have found myself dissatisfied with my job... disengaging from the things I once loved about nursing the most... patient care being the first thing to "take a hit" so to speak. I was increasingly frustrated and annoyed with everything that required me coming up with some form of compassion or understanding. I didn't want to deal with patient's families and I definitely did not have the patience to deal with people who were needy and difficult. Not in my character at all. And also really not good when you work in a place where everyone is very sick and very needy and therefore often times, very difficult to deal with.

Then, last week I was venting to a friend of mine, a woman older than I am and someone who has been a nurse for 12 years now. In the midst of the conversation she told me that I had a "bad temper." Not in a mean way...but in a "let me be a mom to you and try and help you way". I took it pretty harshly and in the midst of already feeling defeated I think it was a definite blow to my confidence and it made me question...

"Am I really supposed to be a nurse?"

Not that I was going to drop everything and decide to switch careers... especially after all I had gone through to get to this point... but it made me question whether the ICU was the place for me. So, I took a moment to step back and evaluate what she might have witnessed recently that would lead her to say this about me. I honestly don't see myself as one who has a bad temper and even my best friends agreed that while yes, I am a bit of a feisty, firecracker... I am not one to have a "bad temper."

Here is what I think I have come up with. In the process of being tired and overwhelmed and I think overworked... I lost something along the way. I got away from what I used to love about nursing and my job suddenly became about performances and tasks and not people. I have been focused on improving and not being the "flunky" new-grad that everyone dreads working with. The typical, work-place gossip began to overtake my job and nursing became more about bureaucracy and politics than it did about being a caretaker and an advocate. When you are tired, everything frustrates you and when I am frustrated... you see it on my face.

On the flip side of that I think there have been some real parts of my job that have been an external cause of my burn out. People have been calling in sick a lot and because of budget issues we often times don't get adequate staffing and because everyone from management down to the nursing assistants are feeling like there is a lack of support...everyone looses. The question I have been asking myself in the midst of this is...

If I am the patient advocate...than who is mine?

I don't fully know the answer to that yet, but what I do know is that I am supposed to be a nurse. My journey in becoming a nurse was something that was so divinely orchestrated... I just have to trust that I am in the right place. I have always believed that God gave nursing to me as my destiny and purpose and in the past week or so I have consciously taken a step back and literally prayed that I would be able to go to work with joy and not dread... That I would be able to love my patients and be their advocate and hope that God would be mine...

And you know what? Something did change... I consciously made the effort to give compassion and have patience and to listen, and I can honestly say that I don't dread going to work anymore. I am aware that I am in desperate need of balance... right now more than ever.... but I don't feel like it is completely unmanageable. It's a part of the journey into this crazy world of critical care nursing and I think its part of the territory for a new grad like me.... and really, in the end "this too shall pass" and for that I am so grateful.

The two dreaded words a nurse will ever face...

Burn Out.

I never thought I'd say it... well at least not this early in my career... but I feel it. Completely and all consuming. I am burnt out! I am tired and overwhelmed and despite the fact that I have had 6 out of the last 7 days off of work... I am dreading returning tomorrow. Partly because I will be working 8 out of the next 10 days....all 12 hour shifts.

yup, that's 84 hours of work in the next 7 days...

ugh, I just felt my stomach sink. Maybe its the combination of being short staffed and over worked and tired and feeling like I haven't had a lot of support recently. Maybe it's also a product of getting tired of the gossip that constantly floats around our unit.... nothing awful, just little bits of people's opinions that come out here and there. It's exhausting to deal with.

Anyway, it's why I haven't posted about my nursing life recently. My nursing life has been tiring and hard. Not exactly the kind of thing you want to write about when you are desperately trying to run from it at all times. I have been really enjoying diving into my photography and reading and getting good, quality time with close friends and new friends recently. 

As a matter of fact I just had an impromptu dinner party tonight that was such a blast! Pictures soon to come from that.... As well as a Vancouver post and a post on a big topic that has been lingering within my group of BFF's recently... being single.

In the meantime... if anyone has any tips on dealing with burn out in the work place... I'm ALL ears. 

Here's to a (hopefully) good week ahead!