Finally, I'm back

It's been awhile. I don't think I need to explain. Grad school, divorce, thesis, work, Life. I'm finally me again. I have to put a shout out to one of my current students. Thank you. You reminded me of who I am. Note: interaction is not word for word. Him: "Hey, I don't want to be weird, but I think I read your blog" Me: "Oh yeah?" (Oh god what the hell was my last entry) Him: "Yeah, it was a huge reason I wanted to do this program." Me: Stunned. "Thanks" (held back tears...If only you knew the shit I've been through and the stupid mistakes I've made and the multiple times I've jeopardized everything). I'm so bad with names. I am still trying desperately to get his name. His nametag is flipped around every time he's in my group. Dammit. So, here I am. The ARRRR N. Now an (AG)ACNP-BC (so many letters!) who is teaching the youth not to eat their young. Teaching. I love it. I'm me again. My students are awesome. But I think they all are. Side note: this post coincides with Robin William's suicide. I have been on that brink, even as recently as a year ago. I cannot tell you how much it breaks my heart that he listened to his demons, but in a sad way I understand. Today, I was very sad while entering work. One of my docs and I had a long conversation about demons. He had a fight with a friend the night before. I had fought with someone I love. We laughed. He said, "You know, I am so outside of myself while I'm here. It's like a drug. I escape my reality by taking care of others. Instead of cocaine, and I've been there- I'm here, escaping into other peoples' lives." Yeah. I get that. We hugged. I took the next patient. She needed what we call "a turkey sandwich and a hug." Some days, yup, that's all you gotta give. It's nice to be back, standing on my feet. Solid.

October, overwhelming.

Healthy or paralyzing fear?

Depends on the day. This program is a huge step up in everything that we're doing, and I really love what I'm learning. The stark realization of responsibility hits me every 15 minutes or so and I find myself nearly panicking - then I remind myself that there are two years left and I'm just beginning this program, and somehow I head back into studying.

Yeah, it's exciting. Sometimes I look around while at UCSF and I can't believe I'm there. It's everything I've ever worked for, and I'm doing it.

So many changes in life- it's amazing what a mere 8 weeks will teach someone. Burning Man was pivotal for me in so many aspects; I loved being a med supervisor and really connected with a group of EMS personnel who are just as goofy and fun-loving as I am. They were people who listen to each others' stories, understand one another. I felt more at home than I have in a while. And the gifts that the Playa provided! I can't even begin to articulate my experiences from this year, because they were so profound. Returning home from Black Rock City, I felt as though my lessons continued, and I felt ready to embrace life in a way I haven't for a very long time. I felt alive again. I still feel that. And I knew some changes had to occur. Which brings me to: Will is most likely moving to LA, where his world, life, work exists. He travels all the time for work, which is great- he's awesome at what he does. But leaves me alone. A lot. I think he's been home at the most 10 days in a row this year. Yes, what does that mean? I'll deal with that later. I can't even begin with that one.

All I can say is that in this past year, I've been lonelier than ever. But that's about to change.

Suffice to say I'm glad I'm in school, where I can get lost in learning.

Here we go.

New, new, new.

Everything is new. I'm getting inundated with emails from school for stuff I need for my Master's degree. I started a new job. I work days, mids, whatever I want and make a little more money. I'm in a new ED. New doctors. New system. New everything.

At Burning Man: new camp (we're not running a theme camp this year). New place to camp. New position in ESD- transitioning from volunteering to being really involved. Out there for two weeks- I've never done that. New, new, new.

A little overwhelming but it's going okay.

Reminding myself to take a timeout to breathe.

Anniversaries and such.

That's the Iron Door Saloon, in Groveland, CA. It's the oldest bar in California, and you might recognize it as "that place I stop into on Highway 120 on the way to Yosemite." We Tuolumne River guides recognize it as "the closest place to get a beer" and "Karaoke Night" (aka Thursdays in the summer time).

It's also where Will and I met.

In fact, it's also where we had our first kiss.

August is full of anniversary stuff for us; for example, we first kissed on August 3rd. How do I remember that? Because our friend Chelsey had an epic birthday party that happened to fall on a karaoke night (Thursday) at the Iron Door Saloon, and it was amazing that we all were able to guide the next day. We took a group of 25-35 year old tech gurus from Chicago down the river on a two-day trip leaving the next morning, and it was probably one of the most memorable trips in my 15 years of guiding. Will wasn't on that trip, but we ran out of beer by 5pm (the rafting guests drank ALL of it by 5pm) and then ran out of wine by 6pm. So what did we do? Naturally, we used the satellite phone to call the ONE person we knew would be up for a mission: Will. He hiked in 4 handles of rum and 8 liters of mixer with his guitar and made it to our camp by 9pm. I remember the entire group cheering as they saw his headlamp bobbing down the trail from Groveland to Indian Creek on the Tuolumne. He then stayed and played songs until midnight, hiked out and worked a one-day trip (18 miles of river in one day), took out from the water with us AND was our bus driver due to his Class B license at the time.
Epic.
He's kind of awesome that way.
That was one of the coolest instances in our relationship

Also in August was our first trip to Burning Man, also known as Black Rock City, Nevada, also known as The Playa (not pronounced "player" but "plie-yah"). It's where we fell in love, it's where we got engaged, and we also got married at the temple there last year, dressed as Unicorns, by our friend and reverend "Pastor Prime" (get it- past her prime? nyuck nycuk nyuck).


See?

August was awesome.
And for those who might be wondering, October is our "default world" anniversary, where we got married in the state of California and made it all legal and stuff with our families.

September, however, will be tough for anniversaries.

What some of you may or may not know is that on Sept 24th of 2010, Will was supposed to be leaving for his bachelor party. It was a Friday. I was driving on Highway 80 towards Roseville, having decided to go check out lingerie and maybe go have a night with my girlfriends in Truckee.
Will called me, "Nicole, Paul is dead."
"What? Don't say that. It's not true."
"Nicole, he shot himself this morning. Justine found him."
I immediately pulled over on the highway and vomited.

Paul was Will's best friend, our best man, and was deeply in love with Justine.
I didn't blog about it last year because I didn't know what to say. I still don't. Paul was one of the most amazing people I knew: he was an expert river guide who, even with a below the knee amputation, could run faster down a river bank, could guide crazy Class V heck even Class VI rapids, and could do more than the average person ever dreamed of. He was larger than life. He was incredibly loving. I remember when he took me and Will aside and showed us the ring he was going to give Justine later that week, and the sparkle in his eyes, and how excited he was. I don't remember a Paul who was depressed. I don't remember a Paul who would ever have left this world intentionally.
Here's how I remember him (he's in the dark t-shirt, Will is closest):



We went to his funeral the weekend before our wedding.

Paul and Justine's wedding anniversary was October 11th. Ours is October 10th. We had kind of planned it that way, and had spoken about celebrating together over the course of our lives.
That's gone now.

It was horrible. It still is horrible. Nobody will ever know why. Many of us blame ourselves for not seeing something sooner.
Having to go forward with a major celebration of love when one is grieving is emotionally confusing. Trying to support Will in losing his best friend when I've lost a friend, too, is a balancing act. And then there's the fact that when I write about all of this, I feel like the vocabulary is lacking.
I feel selfish on so many levels- I wish we had a wedding that wasn't overshadowed by grief. We celebrated, but we were definitely subdued. I wish that Will had actually been able to go on his bachelor party- he's planned so many for other people and was so excited to have had one for himself. He deserved that.
And I wish Justine had Paul back. She is one of the most amazing women I've ever met, and her grace in all of this chaos has been impeccable. I cannot imagine the hell she has been through.
And then I know my feelings and my grief, and yet, I still feel selfish for wishing it had never happened.
But it did happen. And I'm angry and sad and mad at myself for being angry, and feel powerless in the wake of all of this death.
And I can see how much it's affected our relationship (Will and I) over the past year. To say that "Things have been hard" is an understatement.
And I don't know how any relationship can survive something like that.

Sometimes I still have trouble taking care of people who are 5150'd in the ER. I had a woman wake up, intubated, after trying to overdose on benzodiazapines, and when she realized her husband was there, she started crying out of shame for what she had done and relief that she was alive. She got help.

I wish I could have helped my friend.

So, yeah. Anniversaries. Some are beautiful and meant to be celebrated. And some are laced with incredible sadness. This time last year, my friend was still alive. This time last year, Will's best friend was still alive.

People can throw quotes at you all day long and can offer hugs and reassurance, but nothing, NOTHING takes the place of that person in your heart.

This year at Burning Man we will have the Temple of Transition. I have a lot to bring to it, and I know where my heart will be as I watch it fall.

Teaching.

That photo is off my boat on the Grand Canyon, which was a sweet trip.

Full circle. Two years after starting the MEPN program, I'm now lucky enough and crazy enough to help teach new MEPNs. I'm river guiding rarely, working as a nurse in the Emergency Department a LOT, and teaching to really fill my soul.

I never knew how much I'd love teaching.

I also never knew how frightened I'd be to re-enter the Master's portion of this program.

So, I had to leave my Level 1 Trauma Center job in order to teach, so now I work at a Level 2 Trauma Center, hopefully going to be splitting a dual appointment with the Emergency Department and perhaps the PICC/IV team. Days, thankfully. I work DAYS. Sweet.

Night shift made me insane.
But that's not what I'm here to blog about.

I wanted to talk about teaching. It's been challenging, for sure. I watch the new students get so excited about the smallest part of nursing they get to experience. I watch their faces light up when they help a patient make a small achievement for the day- and for me, that's the real reward. Sometimes they get so lost in details that I could scream (oh, the questions), but I know it's part of their learning process and I want them to ask, ask, ask.

Their passion is amazing.

So we were talking about inserting nasogastric tubes the other day, and one student asked me, "What if they bleed? Or what if you hurt the person while you're doing this procedure?"
To which I replied, "Well, sometimes you do hurt people - I mean, it's not comfortable. Do you harm them? No. But you do hurt them. You aren't always doing something nice - sometimes you're doing something that is really uncomfortable."

She stated, "Wow. You must kinda lose some of that connection, you know? I mean, ER nurses must learn how to not care."

I blinked. And said, "No, you never stop caring. If you stop caring, you leave nursing. You just learn to differentiate between what's actually harmful and what's necessary for healing. I've refused to do things before. People have the right to say no. And you get used to how procedures go. Not every procedure goes perfectly every time. You just do your best."

And I realized I meant that. I could have told her about my patient the other day whose heart stopped mid sentence and was a DNR, and how even though I was still taking care of patients that day, I stepped into the room with the family and cried for 15 minutes with them. And that I still think about her.
I could tell her that I walked into a room with an intubated patient, noticed her BP was sky-high and titrated up her sedation and spoke to her in soothing tones, and watched her heart rate and BP drop to a more normal zone. I could tell her that I never say anything bad about my patient even if they're sedated, because I assume they can hear me, and my place isn't to judge.
I could tell her that sometimes I judge anyway, and I have to shove my judgment aside. I'm human, and people do stupid things, for sure- but how many times have I done something dumb? Nobody deserves to get hurt.
I could tell her that every time I feel like I hurt someone I cringe inside.
I could tell her that I give 110% to people while I'm there, because, well, that's my job and I love what I do.
I could relate the time I had a guy who learned he was probably never going to walk again, and how I held his hand and my friend Jen held his other hand because he wasn't sure if his child was alive, and how we both stood there and cried with him for an hour, because we had the time to give and we could be there and he said, "Please, please don't let me be alone." And dammit, we weren't going to let him be alone that night.

I couldn't do this job if I didn't care.

Inconsistencies.

I have to say, writing at all in this blog is challenging for a billion reasons, but mostly because *I'm* really not that interesting.
My patients, however, are.
And there's this little law that keeps me from really writing about them.
So I have to get creative. Which I guess is the point.

A little background: still on night shift (hell), married, now cat sitting for a friend (and they are adorable).

And that's life.

"Because you don't suck."

Ok, this morning, I was walking towards my car with another ER nurse friend of mine, someone I really just love because she's a great nurse and actually genuinely kind.
And the subject of double time came up -
we get double time pay when we stay over past our 12 hour shift (rocks, seriously). And she made a comment, and I commented back that my pay was not that much.
And she said, "Why? That's BS!"
And I reminded her:
"Well, they started me at the lowest pay possible. I've only been a nurse for 17 months. I'm a baby."

And she stopped, and looked at me, and said, "You know, I forget that, because you don't suck. You're, like, really on top of your sh*t." (that word is obviously "shot" since I work in a trauma center). "You know how some new nurses just suck horribly? You actually are really smart, and everyone likes working with you. I forget that you're new. You're, like, not really new. You're quasi-new. Some people never get it, and you totally get it."

I blushed. I think I muttered something inane and ran towards my car, waving good-bye/good morning.

But I secretly really liked that compliment.
I am scared of being a sucky nurse. And I'm glad that at least some of my co-workers don't perceive me that way, because honestly, I really care.
So, that was kind of awesome.