Hello, Backbone, "How you doin?"

Thank you ER, for giving me something that I sometimes lack: a spine.
It's been helpful in more ways than just nursing.

I've gained clarity that I've really needed.

Things that I've lost sight of.

In the ER: I am now able to stand up for myself. I know when to ignore, I am better able to figure out when to question, I'm more of an advocate for my patients.

In personal life: I have always been able to stand up for myself. I am angered when people underestimate me. Being told that I'm malleable and "easily influenced" even if someone feels that way tells me that they severely underestimate me and they seriously overestimate themselves. I am much stronger than most people know. Part of that is from reading the "Ancient Art of War," which allowed me to keep my guard up, no matter what the situation. I am quiet when confronted in interpersonal interaction, which is often mistaken for weakness.
And I am certainly strong, in ways people don't even imagine.

Will is one of the people who has never underestimated me, which is why I love him so much.
In any case, I am happy to have found my spine again. And I am deeply happy that Will is back and here with me.
This time is a special one. I am living day by day, happily reveling in rejoining and rejoicing.

Intensity, and a Labor of Love

The ER is getting better.
The above image is sunrise at Lee's Ferry on the Grand Canyon.
Being a full-time Canyon guide is on my "Bucket List," and although I've rowed it and guided it, I'm not a full-time guide with even 20 trips under my belt.
But my heart is still there.

There are certain things in your life that grab hold of your presence so intensely that you know immediately if your heart belongs there or not.
Nursing, and the experiences I have every day in my job, validates this more than anything.

It's so much a labor of love. I read my friends' blogs and I realize more and more how much our time in nursing school was dedicated to really loving people. I see it every day in my ER when I take the extra second to be kind to somebody and they thank me.
We were raised well.

Love is giving freely. "Love is patient, love is kind. It does not envy, it is not proud..." one quote from the Bible that I can hang with (1st Corinthians 13 something, forgive the absent mind of the Catholic schoolgirl).

The river has my heart and soul.
I am deciding whether I can give it elsewhere. My patients get my heart every day. I am someone who loves deeply. I have to recognize this and love it in myself.
I have a capacity to love many people. I also have to recognize and embrace this fact.

Just like I embrace the sunrise over the river.
Just like I embrace my dreams and goals.
Everything we do leads us to something better and more amazing for ourselves. I truly believe this fact.
And now, I just need to live it.

Climbing Behind a Waterfall (an allegorical anectdote)

This photo was taken in September of 2004, while I was on a Grand Canyon trip. This exact spot is called "Elves' Chasm," and it truly looks like a place where you might expect little people to pop out of the crevices around you. The waterfall is stunning, and you can crawl up behind it and jump into the shimmering, clear pool below you. There are seven pools you can explore, each one more dazzling and more difficult to access- in fact, I know of someone who fell to their death while trying to climb to the top pool (that's another story). There is no safety net. There is only your impetus to explore, and your awareness of your actions.

That's how I feel right now.
Acutely. Aware.
Of all of these things.

Those who know me know that I have an incredible fear of heights, to the point that even bouldering in a climbing gym terrifies me. I've made it to the base of the cables on Half Dome and couldn't bring myself to go further.

So the fact that I took this picture is actually very sacred and telling to me. Even though I was afraid to climb behind that falls, I did so, and I was rewarded with this amazing, dynamic view.
And guess what?
In the end, it wasn't that bad.
And guess what else?
I jumped.

I jumped into that clear blue pool below and laughed and cried and was given hugs and then I climbed up to the next pool, and the next pool, and the next one. I haven't been to the uppermost one because it was just too treacherous at the time and we didn't have the equipment to get there. But I pushed my boundaries, explored, and was rewarded with an awareness of a place that I will never forget, and one that I long for.

There are pieces of me that I have missed deeply, and I am reconnecting with them now. I feel like I've been neglecting aspects of myself that are central to who I am.
And I'm ready to climb a little bit.

Nursing is like that every day, and yes, I'm talking about nursing and stepping out on a limb and being afraid of what I do and the consequences that my actions have for others, but I'm also not talking about nursing.

I'm talking about life.
I'm talking about love.
I'm talking about living.

My meditation lately has been:
Meditating on the idea that courage comes from love (coeur, corazón), and fear comes from the unknown. I embrace unknowns; I choose courage.

This saying has been one of mine since the end of high school. It has every bit of the same importance right now in my life.

We must be gentle and kind to one another, and help each other explore. We must help each other reach those pools, those places that are difficult to access, but open us up to a world of beauty. It requires trust, faith, and patience.
Regardless of if it's nursing, or if it's vulnerability, or if it's acknowledging each other and ourselves for who we truly are, and loving that especially.

That's all.
Oh yeah, and here's Elves' looking up at the waterfall (different perspective is always good)

Bunnies have more fun.

No, really. That's me, at Symbiosis festival, doing medical work.
It was a pleasant relief from being in the ER everyday and having my ego shattered.
A lot has happened since I last blogged.
For one, I'm engaged. Awesomeness and love.
For two, I'm taking steps towards being less afraid of other things in my life. I can't elaborate here, but wow when you are open, life hands you some cool surprises. Some of those are worth waiting a long time for, and I am incredibly struck to the core by what can happen when we manifest our intentions.
For three, I feel like I suck as an ER nurse, it's okay. I've decided my work environment is destroying my soul, but I'm learning a lot, so I gotta suck it up and go with it.
Hopefully all will be well.

That's the news for now.
Aside from pushing Epi IV, which I'm sure I'll repeat.

Stay cool California. Or wherever you are.

Unicorns and Rainbows and such.

I write a lot about nursing, and have written some about rivers, mostly because that's what my life has consisted of.

But now I'm gonna write about Unicorns.

Since I was a kid, I loved Unicorns. And now that Burning Man is coming up, we have actually created the Unicorn Ranch, which is a place for special hard-to-find people to be found. Maybe. If we like you.

It definitely will be serving pink fizzy drinks.

Watch for updates on our awesome camp. My sister and I are painting the artwork for it, so we're having fun with that. Will is getting an extra dome, and we have trampolines.
If you live in a cave, and don't know what Burning Man is, go here:
www.burningman.com

I can't explain it to you. For those of you who know, but haven't been, you need to come.
For those of you who know it was better next year... I can't wait to give you dusty hugs!

Adventures in Big Emergencies.

Yesterday was actually pretty good, sorta. I missed a cardioversion which went on just after shift change (8:00pm), but I was exhausted. The ER is either going to kill all love and sympathy I have for humanity, or make it grow, or both.

The morning was pretty mellow, basic, a few definitely emergent-but-not-life-threatening things happening, and then all of a sudden, things heated up.
Within an hour of each other, we received a stroke patient, a patient having a bigtime cardiac arrhythmia, and then someone who was pretty septic with dangerously low blood pressure, out of it, and was pretty much circling the drain.
3 patients, three real emergencies. Ready, GO!

Sigh. When starting an IV on my cardiac patient, I didn't put the best pressure on his vein, so he bled a little bit (not a lot), but a little. His BP was really REALLY high, too. And he was scared.
And I will tell you this:
If you're a new nurse or a nursing student, listen to me carefully:
ALWAYS give the patient the call button before you leave the room. Even if they don't use it, they cannot be (as) upset with you if they have a way to get in touch with you.

Someone who was doing a test told him when he asked for one of us (literally 2 minutes after he had been stabilized and when we had just finished drawing blood and left the room to send it) that he would be lucky if someone actually came. First of all, that attitude is BULLSH*T, and secondly it's not true.
So he peed in the bed instead of calling and asking for a urinal or a bedside commode.
If he had the call light, he could have called for me or another nurse. So, that's the call light issue. Oh yeah, and this patient was relatively young.
I guess later he also figured out I was newer and was upset - apparently about the blood that leaked from his vein when we were getting his IV in. On the up side, I noticed that his O2 sat had dropped when he told me he felt confused, I figured out, "Oh hey, maybe it's because your oxygen is low and you need just a little bit. Sweet." On the down side, later that day, I also watched communication breakdown happen with him (and with me! I love it when people make major decisions about a patient and don't tell the nurses). It was a recipe for disaster, but the patient is okay, and that's what counts, right? Sigh.
Part of me felt like, "Wow, I totally understand how this person is frustrated," and the other part of me felt like, "Um, we just saved your life. We have 4 other super acute patients and I'm doing my best to chase down the doctor to make sure you're ok. Couldya throw a thank you in there somewhere?"

Be good to your hearts, folks:



Our stroke patient had a whole 'nother story as well, but that one involved a good catch by me: "Wait a sec, we can't give this med- the blood pressure is sky high but the heart rate is under 60, we need a different one...." and some love towards the folks upstairs to get them to admit our patient with a super high BP.
The one circling the drain- well, when we get people that sick, our ER will drop nurses to 1:1 ratio, so that we function like a mini-ICU until people get stabilized. That works really well.

So, I still feel slow, my skills are slowly coming back to me, and for the most part, I'm getting it. It's week 4 for me in the ER, so I'd hope so. I'm glad I have another 20 to go before I'm considered a full nurse.

Some people are stronger than you think...

Every day is a new set of amazing stories. I see so many different people in a day, and I'm amazed at what I get to learn, see and do.

Today was a really good day. In fact, this week has been a lot better.
I actually have the ability to chart on patients, I know where stuff is in the Pyxis (the medication machine), and my IV start scorecard has improved drastically. Like I'm at 80% now - I'm just working on stopping the bleeding after I insert the catheter.

Tentatively, I'm starting to feel like a *real* nurse. Sorta.
I took on two patients on my own today (the standard is 3 to 4), and I'm getting the rhythm of it. The most awesome thing about the ER is that for the most part, the nurses and the docs really help each other out. The teamwork is stellar. I've learned which nurses will leave you 4 straight caths and bloodwork to do at the end of their shift, which ones spend more time freaking out than working, and which ones see that you have a new patient and will help your other ones to the bathroom or draw the blood or help with a procedure when you're swamped. There are more of the helpful than the selfish ones in the ER, and that makes me happy.

This week has also been full of good lessons.
A 90+ year old man attempted to break my thumb today. He was confused, ripping out lines, his oxygen levels were low, and we had inserted a Foley catheter. Poor guy. I think I'd try to break someone's thumb if someone came at me with a Foley, too.
In any case, of course it came at the time that 1) we were supposed to take him upstairs to his med-surge floor on a heart monitor (and he didn't want the lines on him), 2) I had 3 other things to do for a patient going to CT scan who was worried she had cancer, and 3) I had to pee really bad (number 3 being the least important).
What do you do with someone who does that?
Me: "Hey that is NOT okay. You are hurting me. Let me go NOW." I grabbed his wrist, bent it enough to loosen his grip. I am acutely aware that I cannot hurt my patient.
Him: "I don't care if I hurt you. I don't like being here."
He releases his grip.
I sigh. I don't blame him. He's a DNI/DNR, and his blood pressure is sky high, his heart is working at 30%, and half the time he doesn't know where he is, and when he does, he's frustrated because he can't move very well.
We still got an order for Ativan to calm him down. When he tried to pull out his Foley (which sits in the bladder with an inflated balloon keeping it from slipping out) and his IVs, we had to. He was hurting himself.
And my thumb still hurts. But both of us are intact.

Yesterday I had my first violent patient as well. He called me every name in the book - and I told him to stop, that he had no right to be abusive towards me, or anyone else when we're trying to help him.
He fired me as his nurse.
It all started over a lost glove. Apparently the glove was more important than anything else, including the pain he had reported on admission.
The clincher was when he called the very large, formidable African-American security guard a "stupid, fat, n****r." You could have heard a pin drop. I think the patients all gasped and stopped vomiting. All of our jaws dropped. He continued to be belligerent, and demanded to leave. The patient was escorted out by numerous security guards. He obviously had some other major psych issues, but he was threatening the nurses, threatening security, and he swore at another patient. It was nuts. And a good lesson. I tried really hard to talk him down, and so did other nurses, and so did the Doctors and you know what?
It just didn't work. He signed out AMA, cursing all of us for losing his glove. It's the first time I really felt a sense of "good riddance." I feel sorry for him, and if he came back I'd try to help him, but there's a point where you have to cut off the kindness. I reached it.
The funny thing is that I don't think he even had gloves to begin with. It was a surreal experience.

And today, I had so many different people with different issues, it was amazing. From vehicle trauma (trauma!) to heart problems to a possible aneurysm, to Lupus flare-ups, to gallbladder attacks, to insect bites to Septic Shock with some very special circumstances... holy crap.

Kind of like nursing school, except - holy shit - it's real. I'm responsible. For people.

You can bet your sweet ass I'm checking every single medication. Is Vanco compatible with NS 0.9%? Is Toradol? How about Diphenhydramine? How much Fentanyl do you want to give IVP - his pulse is only 58? Hey Doc, you wrote the order for Morphine IM. Did you want it IM or IVP like you told me? Can you change that order?
These are the questions I'm asking constantly. I'm super anal about the meds. The seasoned nurses think it's cute, and they also respect it.
The other thing I'm stoked on is the critical thinking skills we got from UCSF. I can look at labs and have some sense of what's going on with a patient. I know where to look for info on Up-To-Date. It helps me anticipate what's coming, and it really helps in the ED.
I'm really grateful for our assessment skills.

Emergency. My dream. I still can't believe I'm here.
And you know what my feeling is at the end of the day?
I *really* love my job.