Assaulted or A-peppered? Happy Nurses' Week.

I mean seriously, come on.

There are nights (actually, I guess mornings) when I leave the ER and I wonder if people show up just to fuck with the nurses.

Since starting work as an ER nurse, I've been kicked, grabbed, clawed at (I understood that one, though- 90 year old on whom I was inserting a Foley catheter), spit on, yelled at, called every name and *then* some, pushed, and had someone very nearly injure my thumb. And that's just from the patients.
That's not including patient's families.
Let's not forget the MDs who sometimes lose their cool, because even though we're part of the healthcare team, we're still "just a nurse" to some of them.

I've seen tricks, from fake seizures, to "I'm suicidal" right before discharge of a homeless person (because they have to stay on an 8 hour hold after that until the Psych team evaluates them, so they have a bed to sleep in), to "I can't walk" - until that person wants to smoke outside, to "I have 10/10 abdominal pain... can I get a meal tray please?"

And yet, most of the time we just take it all in stride and brush off the mean comments, the yelling, the snide remarks, and know in our hearts that we do our best to care for people who really, really need it.

And sometimes, people say "thank you." You have no idea how much I appreciate those words.
And sometimes we fuck up, like all humans. Hopefully they're small f'ups.

Last night, I had a *patient with advanced cancer (*NB reader, I will reiterate, all patient stories are changed to comply with HIPAA). He was grouchy because he had been there a while, had no white blood cells to speak of, and we had been promising him a room for hours. And then, of course, I missed his portacath when trying to access it. I've never missed before. I was about halfway in and the Huber needle bent, which I've never experienced, which honestly, just sucked. And when you have an already grouchy patient, who has a real reason to be grouchy, who is actually very sick, and you're trying your damndest to do something good for them and you fail? Well, you feel very much like you suck. I had another nurse re-try and he was successful, and fortunately we got that person upstairs to a more comfortable bed, but yowza, if looks were lasers- I felt like he mustered his last bit of energy to shine some anger on me. I understood, but I had been doing a lot behind-the-scenes to help him out, regarding pain management, paging physicians, and getting the antibiotics and blood going that he needed to help make him feel better. It wasn't so much the missing the portacath, mind you - it's probably the knowledge of impending death, pain, feeling like hell (Hemoglobin and Hematocrit of 7.2 and 21.5, respectively, which SUCKS), and having everyone tell him "soon, you'll get a bed" for four hours... and then me missing the portacath.
And I felt awful. I had worked on his inpatient orders while taking care of three other very very sick people- my least acute patient had an open compound fracture (splinted in place) and was going to surgery in a few hours - and understandably had pain control issues, which I was also having to manage every 20 minutes - and trying to get a doctor to increase an order for dilaudid ("no NOT 0.4mg, we gave him 4mg today. Yes. What?? You want to start with 0.4? Did you see his arm? Okay. I can guarantee you're going to be paged all night. Can you increase it to 1mg q 2 hours?"). My other two were 1) psychological issues with COPD (who went home after her breathing improved greatly) and 2) someone with a BP of 225/115 with blurry vision. Yeah.
And just when it was all almost under control, we get someone who overdosed in to my section- not my patient, but when that happens, we all help out because it's a heavy, heavy workup.

We had an assault patient show up as well. It was 4am, and he was a bit difficult to deal with, and the doc was getting frustrated. The doc asked, "So what did he tell you about being assaulted? Do you think he really was?"
I deadpanned, "No, he was actually a-peppered."
At 4am, that was really funny, and decompressed some of the insanity of the night.

Later that night (or early morning), my mentally ill COPD patient came back to scream at us and tell us that we're all incompetent, and then ask if she could watch TV. She started holding her breath to show us how short of breath she was (yes, after screaming). It was an incredible act, and I just shook my head. She pointed at me and the doctor to say that we sent her to the "Clinic hospital" and we were incompetent. Um, yep, I gave her info on a free clinic where she could follow up for managing COPD and her behavioral issues at her request, and made sure she had directions and a bus token. Apparently, she was angry that they weren't open at 5am on Sunday morning. Sigh.
It was almost as good as the girl in triage who I watched shove her finger down her throat to vomit, and then tell us she had nausea and vomiting. Classic.
I had no energy to say anything. At 6am after working all night and taking care of everything under the sun, I just have no patience for that kind of bullshit.

So, my point being: Happy Nurses' Week.
Someone, a friend of mine who is almost an RN and just finishing nursing school, said she thought that we have "very little power and great responsibility."
I absolutely disagree.
I think with great power comes great responsibility.
I know with absolute certainty that I do my very best every day for my patients, even if I shake my head sometimes.
We have the power to make people feel very comfortable in times of great distress, and sometimes in times of great embarrassment.
We have full on Jedi-mind power to decompress a lot of situations.
We have the ability to mostly let things roll - water off a duck's back, my friends.
We have the trust of both patients and physicians. And of our colleagues.

And we deal with a lot of shit. Figuratively and literally.
So, point being, next time you see a nurse, make his or her day.
Just say, "Thank you."

Spring Cleaning

Those crowbars are on the floor of Will's grandpa's kitchen. We were pulling out drywall and I put the bars down and *gasp* there it was, love in the middle of us pulling down the walls. Kind of awesome.

Between working night shift and planning a wedding, writing has taken a back burner to life lately. Some fun things have happened: I found my digital camera, although it's not charged, so I can share more fun photos of cool things, like the most awesomest pen light EVAR in the shape of a killer whale that my friend Katie sent me as a thank you- and my little kiddo patients love it. *Happy Dance!*

Wedding plans are deep underway: venue, bridesmaids all picked and dresses purchased, DJ, Photographer, on to cake tasting. The worst part is the list of invitations. We have been *agonizing* over the invites. Anyone who's been a bride knows this pain.
Sheesh.

I've also been weeding out sources of stress. This past month, I've gone 50 days without any alcohol (I know, can you believe it?), which was a real eye-opener as far as stress relief goes. Many of us use alcohol to de-stress, and I've had to use other venues, such as walks, yoga, stretching, meditation, tea, art, and of course, shoe shopping. I've had more massages in the past month than I have in the past year. There's been some balance restored. Much needed.
I have also done some work examining (with help) people who have used me in the past or who I have allowed to cross my boundaries - this list includes folks from college to people I work with occasionally, to even patients, and recognizing how much I tolerate without speaking up has lead me to be a lot healthier- and now I let people know immediately if something bugs me. I still have to say in some cases, "If you can't say something nice..." is a good rule, but for the most part, I'm not rolling over on my back anymore.

The smell in the air and the wind and rain has been reminding me of river season. I had a moment, driving up the central valley, where I just flashed back to the first time I drove into a river canyon, and that familiar feeling of love and excitement comes back to me. I can't wait to put my paddle in the water.

That's all for now. Working to get a per diem job, taking another year out from UCSF so I can really have the experience to help me as an expert in the future, and doing work on maintaining and constructing good boundaries.

And I'm also saving up for shoes. Oh my god, shoes.

Vampire Hours.

It's been a while since I've posted, which is partly due to the holidays, and partly due to the fact that I've been on night shift for the past month.

I feel like a vampire.

A couple of things have been developing. For one, I'm actually on my own as an RN next week, which I'm simultaneously excited and terrified for- on one hand, I won't have someone looking at everything I do; on the other hand I won't have someone checking up to make sure I did things right.

The night crew is so amazing at helping each other out with things in the ER, so I have to say I have seriously enjoyed working with everyone all night. The camaraderie is beyond anything I've seen.

The sleep deprivation has been difficult, but I'm lucky enough to be able to sleep between the hours of 8a-4p. Wild. This schedule all stops next week when I work a more normal 1200-0030, or noon to midnight in regular time.

Other wild things: We've had Tornadoes here in SoCal, snow, rain, thunder. I love it.
Today I also had my first experience at Disneyland as a SoCal resident. All I have to say is that "Yo-ho, Yo-ho A Pirate's Life for me" never gets old.

Oh and wedding preparations. More to come with that.

Learning.

Every day I learn, I am humbled by how much more there is to know.
Here's a sample:

I've learned that fake seizures are indeed, obnoxious.

I've learned that asking a parent, "How are you doing?" when their child is sick and in your care goes a really long way.

I've learned that more people should speak Spanish in California.

I've learned not to trust other peoples' charting and to make my own assessment.

I've learned to try for the "tough stick."

I've learned that no matter your religion, there's a special place in hell for people who hit-and-run 80 year old grandma crossing the street to go to church.

I've learned to go to the doctor, even if he's a jerk, because the time you go to him and it's really a big deal, you earn more respect than you ever imagined.

I've learned to never let it go to your head.

I've learned that I will have days where I seriously screw up, and am grateful that nobody is hurt. (Knock on wood).

I've learned that I love what I do.

I've watched other people sit on their asses and not help out when push comes to shove, and I will never be like that.

I've learned that if you tell me the exact amount of pain medication you need, where to start your IV, and that you're allergic to all meds except ativan and dilaudid, then I consider you a GOMER (Get. Out. Of. My. ER.), and I never thought I'd ever feel that way towards anyone. And if you ask me for a meal tray and then tell me you're suicidal after I refuse because I'm waiting for your lab tests? Then you have incurred my wrath and I resent paying taxes for your visit. And I especially resent you if your ring the call light 40 times while I'm in a pediatric code next door.
See this youtube video, it is so illustrative of the crap I deal with: http://www.youtube.com/watch?v=_m64cy1MMPg&feature=related

I've learned that you cannot, no matter what, give more than 10mEq of Potassium per hour or you will cause a dysrythmia. And I have not done so, thankfully.

I've learned that if you call a nurse "honey," s/he will cringe. And will lag at getting what you need.

I've learned that a good charge nurse is really awesome.

I've learned that even a jerk of a doc can be a really awesome diagnostician.

I've learned that when the doctor says stop CPR, you stop. And you realize that you've done all you can.

I've learned that when you start an IV on a kid, you had better damn well get it the first time, but sometimes you don't, and that's okay.

I've learned that really, everyone who is sick and in the ER is afraid, and if you honor that, then you have a way better chance of connecting and understanding what's going on with your patients.

I've learned that the little things really go a long way.

I've learned that I have a helluva lot more to learn.

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)