How I stay sane

Being an ICU Nurse I firmly believe in taking "mental health" days. When I was in nursing school, a good friend of mine used to call it that. I gladly adopted the term and have happily used it for my benefit since. I will admit there were a few (really only like 2 times) where I declared it a mental health day and ditched school and/or work that day. Seriously though, everyone can use a "mental health day" now and then.

When I choose to set aside a day for myself I will sometimes get a massage or a pedicure. I'll rent a few movies that I love and settle in for the night with a glass of wine and some good food after cleaning my house (I can't help it, I'm a total Type-A who thinks cleaning is therapeutic). Sometimes, I'll drive through the redwoods and head over to a beautiful beach along highway one for the day. I'll take some pictures and collect some seashells. Actually, that deserves a post in and of itself; it's really that pretty.

Anyways, I recently spent the day with my best friends and we drove up highway 1 to Muir Beach. It was gorgeous and so much fun; I thought I'd share some of the pictures I took. Definitely my idea of a mental health day :)

This little pup was named Fritz ( I think). He was super friendly and cute and not shy at all about jumping onto our blankets and attempting to steal our food. I tried to get a good picture of him but he was all over the place so it was hard to catch him in focus. I love dogs, but sadly am allergic to them so I don't get puppy love that often.

I love taking pictures of shoes. Especially ones on the beach right before the water engulfs them. :)

All I have to say is that Norcal definitely has the prettiest beaches (sorry socal folks, but we win).

One of my favorite couples..."The Marrieds" as we all call them. They got stuck with this cause they are the only married couple in our close group of friends. We all joke about having a curse of singleness on the rest of us. Seriously though, there is probably a good chance that they'll stay one of the few married couples in our group considering the relationship status (or lack thereof) of the rest of our group. Lucky them! haha, I heart you both.




This is Fred-the-crab. He's named Fred because I name every crab I see "Fred." Don't ask me why. Isn't he cute?


After we had a little picnic on the beach, we decided to hike up a short, but steep path we saw on the side of the hills. On the way down, I decided to collect some of the wildflowers along the path to make a bouquet. I love that my "vase" is a starbucks cup that was recently filled with a skinny cinnamon dolce latte. yummm

I love everything about the terrain of norcal beaches and I especially love the little houses along them. If only they weren't millions of dollars to own...

It was windy that day and luckily our friend Ryan brought two of his kites along. We were a big hit with the kids on the beach that day. :)

The boys trying to set up the kite. haha, I was so amused at how confused they looked the entire time.

This is the beginning of the trail we hiked and my friends sitting at the top. As I was taking this picture, my friend Tim was sarcastically
commenting about the fact that I was leaning towards the ground to get this shot and trying to be artistic...he thought I couldn't hear them.

"Hey, I heard that Tim!" was my response.

I just love the color of the water.

Kelly, me and Helena, two of my very best girlfriends.

I really wanted to build a sandcastle but it never happened. That's alright, I just snagged pictures of someone else's instead. :)

The fog that rolls over the hills from Half Moon Bay. I've seen it thousands of times and every sunset, it is there without fail, and it never ceases to take my breath away.


And last but not least, one of my favorite pictures from the day. The view we saw from the top of our hike.

Hopefully this inspires all of you to go take a mental health day for yourself! :)

My not fun weekend

Saturday night I head into work and not even 30 minutes into my shift, I'm running to the bathroom, throwing up my entire dinner. At first I thought it was because I had just been stuck in an isolation room with a detoxing alcoholic and cocaine addict. It did not smell good in there and it was very warm to boot. I gave myself a few minutes to sit and take some deep breaths, hoping the wave of nausea would subside.

No such luck. I ended up getting really sick and eventually told my charge nurse that I needed to go home. Before I left, a few of the nurses on my unit insisted that I stay and get some fluid before I went home. I think they saw how pale and awful I looked and decided I had no choice in the matter, haha.

So, I ended up sitting in the hallway while a friend of mine started my IV and another friend grabbed a bag of LR. I couldn't help but think, "this is going to make for a great blog post."

"I have a really good one on my left hand or my left AC. You take your pick." I told M. as I started to lean my head into the trash can that she had pulled next to me.

She picked the one on my hand and got it on the first stick. Thank goodness I work with a bunch of ICU nurses who are great at starting IV's.



Beautiful blood return and everything. I was actually pretty dehydrated so M. was nice enough to start a 22G instead of an 18G. My veins are already small. Geez, looking at this picture, even my hands look pale.

Anyways, after my liter of fluid, I drove home, dry heaving the whole way. It was awful and for the past two days I have been doing nothing but lying in bed until I am forced to head to the bathroom for more trauma. I tried a couple of times to eat, but it just gave more ammunition for my stomach. At first I was afraid it was food poisoning but now I'm sure it's the stomach flu.

Today has been better though. I found some leftover promethazine from a previous stomach flu last night, popped in 25mg and slept really well. I've even been able to stomach a few bites of soup, jook (chinese rice porridge) and applesauce. Thanks to my dear friend Helena, who brought me the jook and some sports drinks, I've been able to stay relatively hydrated. Still, I'm going at probably 50%. I got up and threw all my bedding in the washer, changed my sheets and cleaned up my room. It took me forever and now I'm completely exhausted.

So, I've crawled back into bed and I'm watching my recent netflix shipment, The Hurt Locker.
Hopefully I'll find the energy to actually get up and shower at some point. Ugh, I hate being sick.

Warning: ICU Rant ahead

There is something you must know about me. One of the most important characteristics in people, in my opinion, is work ethic. There are few things that will cause me to automatically lose respect for someone. Being lazy is one of them. I am all for relaxing and taking care of yourself. I'm even all for letting the housework go for a while to enjoy a lazy weekend. One thing I don't understand though is people who just simply don't do their job. Especially in nursing! If you don't like taking care of people, then don't be a bedside nurse.

Last week I was resource for the unit and being on the night shift; one of our duties is to give our patients bed baths and change their linens. If you have two patients, usually you begin around 5:30 am just to make sure you get both patients done with meds given and anything else that needs to be finished before 7:30am report. If you have someone with a lot of dressings changes or other things you start even earlier.

At around 6:15-6:30am, I had finished helping everyone on the unit but one nurse. Traditionally, its an unspoken rule that you clean your patient up as much as possible and then when you need help turning them and changing the linens, you ask for help....from the resource or nursing assistant. It shouldn't take more than 5-10 minutes of that person's time because there are a lot of people to help, especially if the unit is full.

Well, by the time I made it around and we had only an hour left, this nurse was sitting at the computer, checking email or doing God knows what. When I ask if she was done already, her response was, "No, I haven't started. You want to start him for me?" and points to one of her rooms. My jaw almost hit the floor, especially considering that one of her patients was the guy I posted about recently...the one who is still a full code but should probably be a DNR. This guy takes at least an hour in the mornings because you have to change all of his multiple dressings.

Come to find out later that this is a common theme with this nurse. Everyone told me that in the future, you either don't ask if she needs help at all, because she will take advantage of you, or you have to blatantly tell her, "I will come back and help you when you are ready to turn your patient."

This isn't the only thing I have noticed either. When watching her patients while she is on break, her vitals usually haven't been charted for hours (we do them hourly on our unit) and her bedside tables and rooms are a complete mess.

Luckily, she is one of the very, very few nurses I work with that are like this. Truly, I work with some amazing, hard-working, smart, compassionate men and women. I am proud to be here and am so thankful to have a job. It just drives me mad when others don't appreciate it the same way.

Ok...End Rant. :)

How to spot a night shift nurse

The other day I was walking into the break room at work, just before my shift. As I came down the hall I could hear people exclaiming,

"I slept so good today! I got a full 8 hours!"
"Oh not me, I slept maybe four and this is my ninth day" replied the other nurse.
"Wow, I don't know how you handle that!" I replied as I walked into the room.
"Hah, do I LOOK like I'm handling it well?" We all laughed.

Probably the most common topic all night shift nurses have is sleep. The first thing we do when we see each other is say hello and then proceed to ask how many hours we slept that day. We exchange tips and tricks on the ways we manage to get as much sleep as possible. Ambien, trazadone, lunesta (yuck, I hated that one. It leaves this TERRIBLE taste in your mouth all day) benadryl, nyquil, advil PM, tylenol PM (by the way all of which are basically benadryl with other stuff added). A glass of wine before bed, those funny looking eye covers, black out curtains. Some of us switch our schedule on our days off and actually try to stay up during the day and a few of us don't (most of the time that's me).

Either way being a night shift nurse isn't always easy, especially when you work 12 hour shifts. Still, I prefer it over days because I get paid more and it is usually less stressful. You also learn to be very independent because you don't have all the resources around like you do on days. When you don't trust what an intern decides to do about your patient's crashing blood pressure at 2am....you learn to call the resident or the fellow. You learn to trust your intuition and you learn to ask A LOT of questions. Especially being a new grad like I am.

One of the ways I have learned to handle night shifts and 12 hours shifts much better is by making my food at the beginning of the week. Seriously, the last thing you want to do when you stumble home at 8am is make your lunch or dinner for the next night of work. You also don't want to have to put together breakfast if it means cutting into more of your sleep, and you sure as hell aren't getting up early to make food either. Plus, it stops me from eating junk food that is laying around my house or at work. Nurses are the worst at bringing sweets and fattening stuff to work.

So, I decided to take pictures and maybe share some of the recipes I have from what I made this week. This can help anyone who has a busy schedule; for 1-2 hours of work you have food for 5 days. I did this (sometimes) when I was in nursing school and working 18 hours a day, too. If I had done it every week then maybe I wouldn't have gained the 30lbs I did. Stupid nursing school.
Well, here's to eating healthy from now on!

Asparagus and green beans from the farmer's market by my house. I decided to go the easy route and get pre-cut, baby bella mushrooms (they were on sale).

Lots of garlic because I absolutely love garlic. Some chopped white or yellow onions too.


Some garlic powder, salt, pepper and a bit of olive oil to saute it all together.

There's one of my veggie dishes. Next I put some foil on my broiler pan and on one side had petite red potatoes sprinkled with salt, pepper, paprika and a bit of garlic powder.

On the other side of the dish I had brussel sprouts, some of the sliced mushrooms with garlic, (I really, really love garlic. Can you tell?), sprinkled each sprout with olive oil and salt and pepper.

I roasted them both at 350, the brussel sprouts cook first so I check them frequently and took those out when they were done and put the potatoes back in to finish cooking.

Next I put together some salads for the week. Heirloom tomatoes are my favorite because they're a little sweet, really beefy with virtually no seeds and they don't wilt the lettuce if you mix it in and package it up or a few days. And yes, those are edible flowers also. Another great farmer's market find.

Next, I made some sandwiches and instead of using mustard or mayo (yuck, I hate mayo) I used garlic roasted humus as my spread. Lean turkey meat, avocados, heirloom tomatoes, some of the lettuce from the farmer's market and the 100 calorie sandwich thins by Oroweat.

After it was all almost done I put together my dinner. Some of the salad, brussel sprouts and potatoes. On the side a basil, tomato, parmesan bocca burger (wasn't my favorite, it over cooks too easily and resembles a cement frisbee more than an edible patty at that point.)
The next day I was able to get the day off by using my vacation hours since our census was low. I ended up replacing my bocca burger for turkey burgers. Bread crumbs, garlic powder, tiny bit of paprika, salt, pepper and parsley mixed into ground turkey made for a great tasting turkery patty. No pictures of that though, sorry.
After I ate, I finished chopping up all the fruit I had. Boxed it up and was done. (By the way, I had some of this fruit with fat free cool whip for dessert yesterday and it was delicious and low calorie too!) I also threw some lite, canned fruit in with fat free cottage cheese to have for breakfast.
There it is. I have enough food to last me through 5 work days. I have a good amount of variety and just in case I need some snacks on the side I have fat free yogurt, wheat thins and progresso's healthy soups. (0-1 points on weight watchers)
Yum, now Im hungry. I think I'm going to get some banana bread that just finished baking. Recipe for that soon to come too!

Good Lord, let the man die already!

Before you read this post....I must warn you. My perspective on life and death has been masterfully warped by my job. I see people die often enough to have been relatively desensitized to it. Sometimes I'm surprised with myself and it's sad, and sometimes I'm just plain surprised, "Whoa, the guy in bed 13 coded and died yesterday? Yikes."

As we speak, there is a patient on our unit who has been here for...mmm I'd say about five months. This man's history for the past couple of years is full of, "Stroke in '08, right sided paraplegia, dysphagia, aphasia, pulmonary embolism in '09 complicated by severe GI infection" etc. Seriously the list goes on and on and on.

This man is trached, vented, has a drain coming out of every orifice, (except maybe his mouth) cannot talk, cannot eat except through a PEG tube and with TPN. He has bacteria growing in his blood, urine and stool. He has contractures so severe that he cannot straighten his arms or move on his own at all. He has virtually no muscle mass left in his body and his skin is so fragile that he has hundreds of little skin tears all over his arms, legs and back. We have to change his dressings multiple times a day because his arms just weep serous fluid continuously. And even with that he still manages to soak through to his sheets, of which we have to change frequently as well.

His wife is significantly younger....a May-December romance, if you will. His son looks honestly like he is slightly younger than her (step-mother). Both of them visit every day, sitting at his bedside, talking to him and treating him as if it's any other day the family sat down to watch some TV together. They see him in the deteriorating, painful mess that he is in and for months have decided to (still) make him a FULL CODE. This means that we do anything necessary to keep this man alive. CPR, drugs etc.

Every day I go in for unit report and Bed 8 rolls a round and we all hear that familiar name. "Still a full code." reports the charge nurse.

"You've GOT to be KIDDING me?" I blurt out.

That poor man. I've had many conversations with his family and they insist that this is how he wanted it. He wanted them to fight as long as they could to keep him alive.
Ok, fair enough....maybe, just maybe (which I actually don't believe) he wanted them to do everything possible to save his life. But is this what he had in mind when he thought of living?
Slowly and painfully wasting away, soaking in your own bodily fluids, depending on a machine for your every breath and heart beat?
I doubt it. I can't help but shake my head every time I see him, and it makes me want to go home and fill out my advance directive right now.

I understand that losing someone is incredibly hard but isn't it harder to see them suffer so much? And for what? A few extra months of painfully, laying in an ICU while your disillusioned wife talks to you and sings you nursery rhymes? (Yes, she sings him nursery rhymes) That is not living....it is torture.
Unfortunately, our opinions don't matter. If that's what the family wants, then that's what happens.
At the end of the day all we can do as nurses, is give the best care we possibly can to a dying man.

Photography and Exercise

Being a nurse is hard. As I'm typing this, it is around 3am. I'm taking care of my second open heart patient completely on my own. It has been crazy here tonight. A massive code blue that finally got called about 4 hours into our shift. It was a mess and it's always a little disheartening when the patient doesn't survive. I've learned though, that it's just apart of the territory.
People have been busy and it's been hard to find help. I've been battling my patient's pressures and our on call team to make decisions about it all night. At the moment, I'm nervously looking up at my monitors every other sentence, hoping my patient will hold out his pressures until 7:30am. Praying I can make it through tonight with no major upheavals.
In the past two weeks I have decided to make some pretty major life changes. I've decided to eat healthier and to exercise more...all in an effort to shed some weight and hopefully feel better in the process. I've made it officially into my 7th day of not smoking (yay!). On a personal level I have been making an effort to be more honest and learn to create more solid boundaries with the relationships in my life and in my career.
To put it frankly...it's exhausting. Rewarding (hopefully) but definitely exhausting. In light of that (and the fact that my last post was eons long...haha sorry) I've decided to post a bunch of pictures I took while walking with a close friend this weekend on a trail near my house.

Literally, you're walking down this busy street and out of no where the entrance to the trail pops out...this is what you see.















Life is much happier with pretty pictures, isn't it?

My most memorable patient

When I was in nursing school and in my pediatric rotation, I took care of a teenage boy who had been sent to us from another hospital. He was a cute kid, moody as hell, screamed at the nurses and refused care constantly. Slept most of the day and was basically every nursing student's living nightmare.

Here I was, barely a year into nursing school and in one of the hardest quarters of the program (my peds teacher was the only one to ever make me cry). I get my assignment for the day and as I'm researching my patient's chart I discover this kid had an osteosarcoma of the femur. He had been through a battery of surgeries including removal of a large portion of his femur with a titanium implant to replace it. Multiple rounds of chemo with countless hospitalizations from the side effects and neutropenia and after all of that landed in the hospital because he had gotten an infection in his mediport.

The poor kid had survived well over a year in his battle with cancer and at this point was waiting to hear if he was tumor free. Just as he thinks he is done and ready to go back to school he gets knocked down with a massive infection in his mediport; a staph infection that had spread to his blood.

At this point, it's barely 7am in the morning and I have to go in to do my assessment.
I quietly crept up to him, nervously shaking him awake. Within seconds I had a swinging, screaming teenager demanding that I, "leave him the f*** alone." Yeah, it was not fun. By 7:30am I was ready to pack up my stuff and forget nursing school completely. I spent the rest of the day hiding from my teacher, in hopes that she wouldn't discover I was hours behind on my assessments and charting.

That day was hard because it never really got easier with him. I watched as people would go in and tip toe around him, trying to find a way to actually provide care without pissing him off and causing a huge fit. As I sat back and watched people interact with him and how they talked with him and his family, I started to notice a trend. Everyone was treating this kid as if he was already dead. They were afraid to be stern with him because they pitied him. When they saw him, they didn't see a teenage boy, they saw a kid with cancer who was dying and you know what? I think he saw it too. He knew that he could get away with being awful to people because, well hell he had cancer!

I made it through that day and the next morning guess who my patient was? Yup, that's right. Despite the charge nurse's request to not have students take him on anymore, my teacher pulls me aside and says, "I think you handled him very well yesterday and I think it'll be good for you to take care of him again."

Are you kidding me? What PLANET were you on? But I wasn't about to argue with the person who had my grade in her hands, so off I went. This time was different though. I walked into the room, turned on the lights and said, "Good morning!" nice and loud.
Just before he sat up and was about to begin telling me off up one side and down the other...I cut him off. "Ok, here's the deal. I know you're tired and you're sick and miserable and you just had a crap year full of chemo and cancer, but you're in the hospital because you need our care. I know the last thing you want is to deal with a pain in the ass nurse all day so here's what I'm gonna do. I have to give you medications around 9am. It's 7am now so I will come back at 9am to give your meds, do your assessment and take care of anything else I need to. After that, if you want to eat lunch...great. If not I will see you at 1pm for my afternoon meds and check in. Other than that you can sleep all day. Deal?"

He was stunned. I knew no one had talked to him like that in a very long time and I think, despite his shock he actually appreciated being treated like a normal teenager for once. "Sure, whatever." he says and he buries his head back under the covers.
I take a deep breath and head for the door.

The rest of the day was completely different. He was up waiting for me at 9am and stayed up for the rest of the day. His mom came to visit that day since his dad was busy and the three of us sat and talked about what the past year had been like. He told me all about his rounds of chemo and the horrible side effects he got. He told me about the day he shaved his head and how people reacted to him at school. He joked about how he used his medical ID card as a way to get what he wanted. "Every time my mom says I can't do something I just throw this at her and say, 'CANCER CARD' and I eventually get what I want." he smirks.

We discovered we used to live in the same area and we talked about our favorite spots in the downtown area and how much we loved that town. He told me about his girlfriend and how he was so happy to finally be done with chemo because they had their Sadie Hawkins dance coming up in a few weeks. He hadn't been able to go to any of the dances this year and this would be one of his last chances since he was a senior now. I could hear the sadness in his voice as he shared about the sports he used to do and how he was the captain of the track team and had been on varsity soccer since he was a freshman.
I saw him laugh and joke and smile through the endless shots and IV's I gave him. He even tried to use the cancer card on me once.

"Haha nice try buddy!" I smiled.

At the end of the day I was able to discharge him home. He was lucky enough to have insurance that covered at home nursing care and IV antibiotics at an outpatient center. We gathered up his things, changed the needles on his mediport and gave him and his mom all the instructions he needed for at home care of his IV's. And then I'll never forget what happened next.

He stood up and hugged me.

"Maybe we'll see you around downtown sometime?" he said.

"You bet, kiddo." was all I could mutter. The lump in my throat was already welling up.

Then I watched as he grabbed his things and began limping down the hall. At the time, I had no idea we were supposed to walk patients out in a wheelchair and I had actually never seen him walk. I had no idea he had a limp, but it made sense. He had part of his LEG removed. Then it hit me like a ton of bricks. Here is this seventeen year old boy. Popular, cute, athletic...and in an instant had his whole life...his whole identity ripped out from underneath him. The normal angst and drama of being a teenager was replaced with cancer and hospitals and fighting for his life.

He looked back, smiled and waved. As I watched him turn the corner, my chest tightened and uncontrollable tears began streaming down my face. The gravity of what I had just witnessed absolutely floored me. The vulnerability he had shown and the absolute blessing I had of sharing a mere 2 days with such strength and hope was moving. The resilience of the human spirit was shown to me that day in the form of a young boy who had overcome so much. I doubt he will ever know the impact he had on my life, but at that moment I knew, without a doubt, I loved being a nurse.

I still think about him often. I pray for him and I hope, wherever he is that he is healthy and happy and living life to its fullest. And I only hope that someday I can touch someone else's life the way that young boy touched mine.