Free at Last!

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My 12 day vacation from work has officially begun and words cannot describe how needed this is. For some reason, this week at work has been incredibly long and hard. I have definitely had more horrendous assignments and wasn't extremely busy, I guess.... it was just exhausting.

I have a feeling, the lack of sleep and the fact that I did a 16 hour shift in the beginning of the week, is what did me in. I've also been trying really hard to go to the gym during my break. I try to run at least 2 miles everyday and sometimes I lift weights as well... in light of that, I left work today practically limping my feet hurt so badly.

Needless to say... the week is over and tomorrow morning I will be heading off to Seattle with one of my best friends! We'll be spending a few days in downtown and also heading up to Vancouver for a day!

I can't wait and doing nothing but bumming around a new city, eating, getting coffee, taking some pictures and maybe getting a chance to do some fun outdoors-y things sounds like the perfect dose of medicine right now... that and a nice foot massage, haha.

Some fun suggestions we've had for things to do and see:
The Fremont Troll
Jimi Hendrix museum
Oyster Bar
Deadliest Catch boats in the pier (I love that show!)
Pike's Place Market

hmm, anything else?

Most of the tips I've had from people have centered around food, of course... haha no complaints here. That always seems to be the best part of traveling. :)

When I get home I will have 6 whole days to do nothing but sleep, relax, hang out with friends and catch up on non-work stuff. One of which is going to include hosting a terrarium party at my house! (More on that to come later)

Yay, for summer vacations!

Strange Day

Today has been a strange day. Too many unexpected and unusual things for my liking.

It almost feels like I stepped into a Salvador Dali painting...

something akin to this...




Not to mention that this day started at 10am yesterday.

For a 48 hour span I will have gotten 5 hours sleep...
Who says residents and interns are the only ones who have crappy hours?

Almost forgot one of my best friend/ex-boyfriend/ex-roommate's birthday (thank you google calendar for saving me)... so not like me... especially for those that matter most

Last year his birthday involved a very large, homemade sponge bob cake.... you wouldn't believe me unless you saw it, so here you go.



Discovered another friend....also a previous roommate for a 6 year stint.... had decided to lose 40lbs and join the police academy.

huh?...who are you and what have you done with the person I lived with for 6 years?

Had no clue and realized that in just a few months things can really change a lot.

Have you ever had one of those days where it feels like everything is just a tiny bit off?

Or maybe a lot off?

Today was definitely one of those days.

I hate feeling like I am on the outside looking in... completely lost to my surroundings...

Feeling like I am always forgetting something, or doing something wrong, or missing the point...

well, today was one of those days.


And then... I come to work and I have a fresh, post-op, CABGx3 for a patient...

cardiac surgery, intubated, sedated, spaghetti factory of lines....

I stepped into my routine and suddenly... almost instantly

the world turned slightly back into place...

I took a deep breathe, smiled and thought..

Ahh... home.

The definition of Grace

grace

1. A disposition to be generous or helpful; goodwill.
2. Mercy; clemency.

3. A favor rendered by one who need not do so; indulgence.
4. A temporary immunity or exemption; a reprieve.

When I was a nursing student, and did a rotation at the hospital I am working at now... I hated it. The nurses, the unit, the computer system, and especially the patient population.

"Not for me," I thought "Not for me at all."

"Thank goodness I'll never be back there!" I smugly boasted as I drove by after my rotation was over.

Then, during my preceptorship I ended up in the Med-Surg ICU, at the very hospital I hated the most during all of nursing school. On my request form I had filled out months earlier the one major request I had was, "Please, DO NOT put me at the VA."

Considering my background, I had never felt completely comfortable with male patients. I was intimidated by them and most of the time had no idea how to even begin showing them compassion. Many of the men I had known growing up were abusive or were disrespectul to women at the very least. These men seemed no different to me.

Well, God has a funny way of working things out.

I think back now and I am so incredibly thankful my teacher ignored me. I could not imagine where I would be now without having done my preceptorship there. I am one of the few people in my class to have a job and I love my job. What is even more amazing to me is how much I have learned about our soldiers and the men who have served in our nation's military; another thing I had a not-so-fond relationship with. I had known and dated enough military men to be jaded in my view of them, for sure.

Many of the men I treat in my job are the definition of what I have feared most of my life.

Alcoholics, substance abusers, womanizers.
Domineering, intimidating, dysfunctional men.

In other words: broken, hurting human beings.

Vulnerable and often times alone because they have alienated everyone else in their life. I see that wide-eyed, tear-filled look and I feel the tight grasp of their hand. At that moment everything else is stripped away. What they have done and who they might have been does not matter. My own fears, insecurities and experiences fall away and I no longer see a man that I usually would have despised for what he represented. I see a patient that is afraid and needs someone... anyone to show some kindness. Everything I know about their life disappears and all that is left is grace. Completely undeserved, thoroughly healing, grace.

Why I love being a Nurse

It's been 4 hours since I got off work and I can still feel the throbbing in my feet. I started off the night with 1 patient and ended up with two...a fresh post-op that turned into an open cholecystectomy because the gallbladder was gangrenous. He was fine though, it was my first patient that was tough. Arguably the sickest guy on our unit but my favorite type. Intubated, sedated (every ICU nurse's dream haha). Being able to have a patient that can't talk is sometimes such a blessing. Ok, I know what you're thinking, so hang in there with me. I promise I am not as mean as I sound. haha

This is what I love about intubated patients...

I get the time to focus on every little detail of their physiological state. I have a chance to really tune in and pay attention to their baseline; to read their reactions and to take the time to try and make them comfortable and I can do this without any distractions. I can spend time talking to family and giving them comfort in a time that is usually incredibly frightening and overwhelming.

When I have a patient like I did last night, they usually have multiple factors that are keeping them in the ICU. For example, my patient had aspiration pneumonia, alcohol withdrawal, liver failure etc. He was on two IV pumps worth of pressors, insulin, fentanyl, versed etc. To make a long story short, physiologically there is a ton to manage with patients like this and on top of that there is a person underneath that diagnosis (or diagnoses in most cases).

This is what I love about working in the ICU, with intubated, sedated, extremely sick patients. It forces me to think about the big picture. (Also what I LOVE about cardiac patients) You have to take every body system into account.
His pH is 7.24, CO2 is 65....hmm we might want to adjust the frequency on his vent? What do you think? (usually what I say as a hint to the intern)


OR

Ok my fresh post CABG is crashing with MAP's in the 40's, systolics in the 60's. He's on 3mcg of Dopa, and 0.1 of nitro....neither of those are to be touched...by request of CT surgery. Well we can start a phenylephrine drip but thats risky with a fresh arterial graft and if he has a CVP of 4...and his urine output has been minimal...well, clamping down on his vessels and not perfusing the kidneys is prooooobably not a good idea. He obviously needs fluid. Especially if his cardiac ouput is low but yet his SVR is fine.

Ugh, I love it. I love having to figure out the puzzle of my patients. Taking every system into account and collaborating with people to create a better outcome. Really, I think people underestimate what nurses know and have to study to get to where we are. Especially working in critical care, the learning curve can be pretty great and the examples I gave are so basic! There is always so much to learn and when you have people who are willing to teach and learn and figure it out with you....it's the best feeling in the world. It's challenging and that's what I love about my job.

Then there is that other side of nursing. The side that is able to step back from seeing the patient as just a diagnosis. This, 95% of the time is what new doctors...(and sometimes maybe the experienced ones) often miss.

For example, my patient from last night was on a ventilator setting that is called CMV. Controlled Minute Ventilation. To put it briefly, everything is controlled by the ventilator. Breathing is forced in and your respiratory rate is fixed, how much you breathe in, how much oxygen you get, how much air is left in your lungs after you exhale....all of it is controlled by the ventilator. You have to have the patient sedated on this type of setting because it gives no room for the patient to take his own breath or breathe at his own rate. It is incredibly uncomfortable for someone to be awake, with an ET tube down their throat on this vent setting. Seriously, picture me putting an ambulation bag over your face and forcing you to hyperventilate.....not fun.

Well, the intern who had him today tells me to turn off all of his sedation. When I asked why, his answer was, "We need to have him do a few things for us."

Obviously he needed to do a neuro check, and he must have assumed that I, being a nurse, wouldn't know that was the reason for turning off the sedation. I see the reasoning for it because you need to know if the patient could wake up and follow commands...an important factor when considering whether the patient can be extubated or not. The Intern didn't realize that I had come across this situation before.

At this point I'll spare you what I was thinking and just tell you what I said. :)

"So, you want me to turn off all of his sedation while he is on 100% fiO2 on CMV, so you can do a neuro check?" I try to give him a chance to explain, hoping there is something I've missed.

"umm, well.." the intern begins to stammer.

"You guys aren't planning on trying to extubate are you?" I spared him the trouble of answering my previous question.

I know this isn't even possible but sometimes....you just never want to assume anything in a teaching hospital, plus I'm still trying to hint to the intern that I don't agree with him.

No such luck for me....the intern was obviously very upset that a nurse was arguing with his orders. I could tell because his eyes were rolling so far back into his head I thought he was going to pass out.

At this point I realize that there is no point arguing, so I smile, and nod and I nicely say, "Ok, well I will be giving report to the day shift nurse in a few minutes and I will let her know."

Luckily, one of my old preceptors is taking over this patient (I was so busy they split up my assignment and had two people take care of what I did alone...hence the feet throbbing) and when I tell her about the conversation she looks at me, laughs and shakes her head.

"I know, but you know C. I'm just the nurse and I'm the young nurse so I figured I'd let you fight that battle. My feet hurt and I want to go home."

"Ok, honey, go home and get some rest. I'll just bring it up on rounds when the attending comes in." C. pats me on the back.

When I came back that night, I went up to C. and nodded towards our patient, "Did they end up turning off the sedation?"

"Nope." she says with a smile that had "you should have listened to the nurse" written all over it.

I have a feeling that intern learned a good lesson that day.

I love being an ICU nurse because it is the perfect balance of science and art. It is helping others to remember that there is a person in that bed...not just a diagnosis. Not just a way for you to impress your resident or fellow or attending. It is not just a learning experience or a lesson for you during your 1 month rotation in the place that I work everyday. There is so much to consider and if you would take one moment to listen to me, you would realize that much of what you cannot learn from the patient...you can learn from the nurse that has just taken care of him for the past 3 nights in a row. I'm not a parent but I can only imagine if I'm this protective of my patients....I'd be a force to reckon with as a mom. haha.

And after all is said and done, tired or not, heard or not, it's worth it if it means I have made a difference in my patient's day.

What it means to be a Veteran's Nurse

Golden Gate Cemetery

The other day I watched The Hurt Locker. I rarely voluntarily watch war movies because I'm just not a huge fan of action. Action movies always seem a little pointless to me, but this time I wanted to see it because of the recognition it received at the oscars. Watching any type of war movie always brings up so many mixed emotions. I am not one for war at all. I do understand the need for it...at times, but I just hate what it does to the people involved. Yet, I'm always reminded of what my grandfather, a Korean war veteran, always told me, "Hate the war, love the soldier." And you know what? I do.

I love and respect our soldiers and I feel completely honored to serve them in my career. The more experience I get working at a veteran's hospital, the more compassion and reverance I have for the soldiers in our military. The more I understand that they have gone through some incredibly awful things to protect our country, to fight for our country and to serve America.

It is not a glorious job. It is not one that is always filled with honor, respect and duty. Most of the time I think it leaves you with nothing but drug addictions, alcoholism and severe PTSD. Obviously that's not 100% true, but it is disheartening to see 90% of the patients on your unit have some type of drug or alcohol (or both) abuse. I know I'll never fully understand what our nation's veterans have experienced, having been a civilian my entire life, but I do hear the stories and I am in awe of the men and women who have served.

What has always amazed me about those who are in the military is their steadfast devotion to their fellow soldier. Yes, many who serve are firm patriots; men and women who fight to defend the freedom we have as Americans. But if you asked, many would say they have served on not one, not two, but multiple tours because that is where they belong. "They need me over there," is a response you will hear. The purpose and pride they feel alongside their fellow soldiers is not one that is easily replaced. Their loyalty to their country and their fellow brethren is what spurs them on and for that I am eternally grateful. I am humbled to know that I live in a country with such determined and brave, men and women.

Today, I would like to honor those who have served in our military, especially those who have fallen in combat or while serving. When I go to work today and I inevitably come across a difficult or stressful situation I will stop and remember those who have died. I will let the humility and reverence of that moment take precedent and I will say, "thank you" to the patient I will serve today.

If you know or come across a soldier or veteran today, please thank them. Even if you hate war, like me, love the soldier.

"A Soldier"

A soldier is a nobody, we hear lots of people say.He is the outcast of the world and always in the way.
We admit there are bad ones from the Army to the Marines,but the majority you will find, the most worthy ever seen.
Most people condemn the soldier when he stops to take a drink or two,but does a soldier condemn you, when you stop to take a few.
Now don't scorn the soldier but clasp him by the hand,for the uniform he wears means protection to our land.
The goverment picks its soldier from the million far and wide,so please place him as your equal good buddies side by side.
When a soldier goes to battle you cheer him on the way,you say he is a hero when in the ground he lay.
But the hardest battle of the soldier is in the time of peace,when all mock and scorn him and treat him like a beast.
With these few lines we close sir, we hope we don't offendbut when you meet a soldier just treat him like a friend.
-Author Unkown

Healing comes from the strangest places

I can't tell you how many times I have watched a TV show and ended up in tears. And I don't just mean those "Oh my gosh, how sad!" tears. I'm talking about those all-consuming, debilitating tears that leave you breathless. It is a moment that hits a chord deep inside a place that you had no idea even existed. Let me also say that I am not a typical crier either. I don't tend to be over-sentimental and most that know me would say I'm a pretty serious person and a rather tough cookie. I've survived a lot of hardship in my life and as for my general pain tolerance....I almost fell asleep in the middle of getting a tattoo once, for crying out loud.

That being said....there have been certain moments on certain shows that have really touched me and the other day I was reminded of one.

See, I grew up in an abusive home and as a result (not to be cliche) had to grow up very quickly. At a young age, I became my own parent, my own advocate. Most of the time, if not all of the time I didn't do a great job. I barely survived. I went from an abusive home to an abusive foster home. Then was adopted by my amazing aunt who was in every sense just like me. A little girl who had her fair share of life's curve balls. Curve balls that shaped her into a very damaged and broken person. Once again I ended up in an abusive home. Despite that though, I made it through high school and then pushed my way through a community college because it was all I could afford. At a young age, I moved out on my own in an area that is very expensive and nearly impossible to survive in on a $9.00/hr paycheck, and in the meantime I was falling apart inside. My life was a mess.

Unhealthy relationships, smoking, drinking, partying.
God, faith, church.
People's approval, academic success, eating disorders.
Becoming a nurse.

It didn't matter what it was. If it was a distraction, if it was a vice, positive or not....I used it. I hid from the pain I had and I functioned delicately and very carefully on the surface. I seemed so strong on the outside; so put together. Take one peek inside though, and you'd see a completely different view. You'd see a wounded person who had no idea how to fight for herself. Who did not know, in any sense of the word, how to love or how to value the woman that she was.

Now, fast forward to adulthood. Here I am, in the middle of nursing school. 18 hour days, 5-7 days a week. Working full time, nursing school full time, piling on the credit card debt. Striving to get straight A's (if only I knew back then, that a B was just fine) and studying constantly. No social life, no love life, minimal if any family support. Practically no sleep, I hardly ever saw my friends. The mess inside just continued to grow.

So there I was. Catching up on the most recent Grey's Anatomy episode. It was an episode where Meredith and Dr. Weber (two of the main characters) were in a huge fight. There was a little girl with her mom and dad in the hospital. The little girl had stabbed her father or something along those lines. The mother tried to pretend it was an accident but the little girl....Maddie, explained that she had done it on purpose. See, her dad had been abusing her and her mom. Maybe just her mom actually but it was an abusive home and Maddie wanted it to stop. She fought for her mom and for herself, without even knowing it.

In the episode, Meredith who is one of the residents, confronted the mother. Meredith, growing up in her own dysfunction, fought for Maddie. She saw the inevitable fate of this little girl, because she knew the mother did not want to leave her husband. A problem so familiar of domestic abuse. She crossed a professional line by yelling at Maddie's mom and pleading with her to leave her husband. Dr. Weber, the chief of the hospital threatened to fire her if she did not back off. Keeping in mind that Dr. Weber was the same man who'd had an affair with Meredith's mother and had effectively destroyed her family.
Well Meredith did not listen and was in the locker room, packing her things when Dr. Weber comes in. The scene that comes next was one of those moments I was talking about earlier. You can see what I mean here, it's at the beginning of the video.


By the end of the first two scenes I was in sobs. Not only that, but I was practically curled up in a ball for the rest of the night, crying, trying to catch my breath. Between the scene with Meredith and Dr. Weber and the scene with Izzy and her mom, something had hit too close to home. In a matter of minutes Grey's Anatomy had summed up the pain I had been carrying for my entire young adult life.

"I should have fought for you, Meredith. Like you fought for that child today."

"I should have fought for you."

"You were helpless."

"A beautiful, smart, funny, little girl."

"And no one stood up for you."

"I'm so sorry."

"I'm so sorry"

I felt those words so deeply it was crushing; as if someone had reach into my chest and wrapped their bare fist tightly around my heart. I will never forget how true those words were for me. In my entire life, I felt as if no one had fought for me. Not only was I not worth fighting for, but I was abandoned and abused by the very people who were supposed to love me the most. I had lived my whole adult existence living in shame, feeling as if I was not worth fighting for. Not worth loving.

I couldn't even fight for myself.

And now... just a year or two later, here I am. A successful nurse. An advocate for others. An advocate for myself. A friend. A person that is present in others' lives. A daughter who is learning to love her family better. A single woman, discovering what it means to love herself; to value herself, whether a man says she has value or not. I am not only surviving, but I am growing. I am stronger now. Healthier. Wiser.

And at the end of the day....

I am fighting for me.

Grandma's Banana Bread Recipe

When I was in elementary school, I lived with my grandparents for a few years. My grandma is like a mother to me and has taught me everything I know about cooking, sewing, and basically everything about keeping a house. One of my favorite things my grandma used to make when I was a kid, is her banana bread. There are few things more comforting to me than the smell of baking banana bread. My favorite was when my grandma would get up early and put it in the oven before any of us would even be awake. Just as it began filling the kitchen with that sweet smell, I'd be getting up to get ready for school. It always made my day.

I thought I'd share the recipe with you.

Here's the ingredients you'll need.

1/2 cup cooking oil (you can also substitute this with applesauce for a healthier option)
1 cup sugar
2 eggs beaten
3 ripe large bananas, mashed
2 cups all purpose flour
1 teaspoon baking soda
1/2 teaspoon baking powder
1/2 teaspoon salt
3 tablespoons milk
1/2 teaspoon vanilla extract

Optional:
1/2 teaspoon cinnamon
1/2 teaspoon ground gloves
1/2 teaspoon nutmeg
1/2 cup chopped nuts

Preheat your oven to 350 degrees. Beat together oil and sugar. Add eggs and banana pulp and beat well. Add sifted dry ingredients, milk, vanilla and spices. Mix well and then stir in the nuts.
Next, pour into a greased and floured loaf pan. Bake at 350 degrees for one hour or until a knife comes out clean from the center.

Note: I've never sifted the dry ingredients and it hasn't been an issue. I think it just blends the ingredients more easily. I measure everything exactly except the spices. I tend to just sprinkle in as much as I want of each spice and sometimes if I don't have nutmeg I'll use mace, which is a similar substitute. You don't have to add the extra spices in, but I think it tends to be the "secret ingredients" that really make the bread delicious.
P.S. I used applesauce on the batch you see here for the first time. Definitely, healthier and very moist, but it made the bread very dense and I think I prefer the oil over the applesauce. Both are great though!

Hope you enjoy!