Back to nights: the space to think and teamwork

I had mixed feelings about returning to nights 2 weeks ago, however, as my preceptor, who has the exact voice of Quagmire from Family Guy stated, "you have time to critically think on night; days you just try to survive."

The first night I was able to successfully handle 2 sick ICU patients on my own which was the boost in confidence I had been seeking. I also participated in a code on another night where I did chest compressions for only the second time in my life. It was a well orchestrated dance that I felt like at least I knew my own moves instead of being in the way.

The end of orientation is 2 weeks away, but now a definite point on the horizon. Although I'm not looking forward to flying solo the teamwork is incredible and I'm thankful to be working with such nice competent people. 

This quotation fits well with tonight's mood and is one of my little brother's heroes:

"My work is all about adventure and teamwork in some of the most inhospitable jungles, mountains, and deserts on the planet. If you aren't able to look after yourself and each other, then people die" 

- Bear Grylls

Quotation for a Friday

Environmental behavior : walking & biking

"Walking is man's best medicine."

~Hippocrates 

I might add "bicycling" to that quotation too! According to my Noom app for my phone in the last 7 days I have walked 26 miles and biked 15 miles. This doesn't even take into account the thousands of steps I take during a 12 hour shift at work. 

These last few moves have reminded me how often human behavior is shaped by the built environment. In our previous location I was in my car at least once a day to do anything. Additionally,the idea of walking the dingoes was a chore fraught with stress as dogs would come out of their yards to attack my pups; walking on the street rather than sidewalk was a somewhat safer option but still unpleasant when dodging vehicles.

Our new neighborhood has nice sidewalks that encourage activity and neighborhood community. Like our Portland home, we have met the neighbors and know their names! Parking in downtown here takes just as long as a bike ride to down town and one is definitely better for your blood pressure than the other. Additionally, bikes are fairly common here and cars know to watch for cyclists. I maybe drive 1-2 times per week for errands that require a vehicle - like groceries for the week.

In our ongoing national critique of obesity the human environment is often missing from the discussion. Food deserts breed fast food and unhealthy food options when grocery stores are lacking. Unsafe, unpleasant streets breed more driving rather than walking or biking. It's not surprising our population struggles with its waistline when we spend more time behind the wheel. 

The last 7 months of living rural were terrible for my health and now I'm slowly chipping away at the 30 pounds that I gained there from not enough exercise (despite dogs walks) and the amount of time I spent driving to get anywhere (even if it was to go hiking or walking my 5-7 miles a shift). It was a self study in how environment shapes behavior and it was humbling.

Although in the ICU I do a lot less teaching than I did in the IMCU, this is a consideration that I keep in the back of my mind - where do my patients live? Just like air pollutants or water pollutants can poison the human body the built environment constructed without regard to human body can cause an equal amount of damage. 

There is not an easy or quick solution to these - sidewalks are not poured over night and bike lanes are expensive to build, but the conversations are definitely the beginning.

Into the hot water....tomorrow

"A woman is like a tea bag-you can't tell how strong she is until you put her in hot water."

-Eleanor Roosevelt

Here is to thinking good thoughts about tomorrow - 

my first day in the medical ICU!

View of Table Rock in Boise, ID from my hospital

Gratitude

"Let us be grateful to the people who make us happy; they are the charming gardeners who make our souls blossom"

-Marcel Proust

My mantra for nursing

"Cure sometimes, treat often, comfort always."

~Hippocrates

I have to return to this quote on a regular basis to find my footing, to regain my common ground. This is where Hippocrates' quote must be turned inwards as well. It's not just a prescription for how we care for others, but how we must care for ourselves in order to excel at our profession.

I had another miserable, no good, awful, question my existence as a nurse sort of night. In the course of seven months, I consider 2 episodes like that to be a pretty good track record. 

However, when all hell does break loose, it frustrating the lingering effects it has upon your psyche. I have had four nights off and go back tomorrow night. I even avoided a four hour immediate pay shift (easy money and easy work!) when they were short staffed earlier this week because I absolutely couldn't bring myself to step back in the hospital that soon. I'm cringing at returning tomorrow night even.

I have replayed that 12 hour shift over and over and over and over.....it doesn't matter if I'm cooking, packing, cleaning, walking the dingoes, trying to fall asleep in this horrendous heat, or rehashing it with a coworker. I imagine this is mildly what PTSD is like. Poor souls.

It's going to take awhile to lay that night to rest, as well as feel satisfied that if I encounter a similar situation that I will be able to use what I learned from that night to make it better. 

In the meantime, I'm trying to be gentle with myself and know that reflection is the key to resilience.

Whopper of lesson: withholding judgement

There are a lot of medical conditions that one does not have control over - genetics, environment, and life just happen. People live their lives as best they can and they get saddled with some disease process   that pose obstacles and challenges that we can't even wrap our heads around.

Then there are days when you want to holler some sort of Hippocratic quotation at your patients that seem to have gotten themselves into their predicament, such as these:

1. "Let food be thy medicine and medicine be thy food."
2. "Everything in excess is opposed to nature."
3. "Walking is man's best medicine."

The thing is though humans have a million foibles and it's actually surprising we don't make ourselves sicker or injure ourselves more often.... I am compassionate to the type 2 diabetics and the smokers - I love chocolate and coffee - who am I to point a finger on these addictions? 

These poor folks suffer enough without an additional serving of judgement. My job is to care for them and give them the best tools possible to help themselves. We all do the best we can and we are all in this together with our individual burdens to carry. If we can help each other, all the better.

As a new nurse I had this idealistic view that I would never be judgmental towards my patients. However, the idealistic view got a big whopping dose of reality recently. A handful of times now I have been the nurse for trauma patients that have been intoxicated and driving. It is harder than I imagined to to find a compassionate spot for these individuals when you know the passengers were perhaps life-flighted out of the area and that the patient you are caring for is the perpetrator of the accident and the least injured out of the bunch. 

My nursing assessment and skills are equal amongst all my patients, but these patients have challenged me to remain kind and warm without shutting them out for their behavior that landed them in a hospital bed. These experiences made me think back to some of my classmates that had done a nursing clinical in the prison system in Portland. They told me they made a point not to read deeply into their patients' charts until the end of the rotation, because they knew they could not reserve judgement otherwise if they knew the crimes their patients had committed. 

And so I have endeavored to immerse myself into the medical side of these patients and do my best to forget the trauma that brought them to my unit. I also plaster a smile onto my face because I know scientific research tells us that our body language tells our body what to feel, so by the end of my shift I have moved from a place of judgement to a place of kindness. 

Again, it's been a whopper of a lesson and probably one that will be relearned many, many more times.

A blissful week - I'll take it!

"Gifts have ribbons, not strings" ~Vanna Bonta

This week was gift-like. I am doing my first 3 on/1off/3 on run of work days. I don't know if it's the seasonal change, but my first 3 nights thus far have been delightful patients. On my third night I had one patient all night and reveled in doing a lot of teaching and putting together an informational packet in Spanish for them to better understand their new condition.

Meanwhile, my coworker and I were spying on the ER waiting room (we can see the waiting room from our patient rooms) and it was packed. We savored the quiet we were enjoying, but also anticipating getting slammed with admits. Somehow, not one patient came to the IMCU - and we did a dance for joy to be skipped over this week.

Now onto the next set of 3 days!

Sage brush sunrise

I live a blessed life where I see both sunrises and sunsets every day that I work because I am awake for both. My last night at work this week was crazy busy and I came off my 12 hour shift with a big dose of adrenaline, so on my drive home I stopped and snapped some photos along the way.

sunrise in the side view

sunshine in color, review mirror

sage brush sunrise


"Keep your face always towards the sunshine- and shadows will fall behind you"
-Walt Whitman

Yuletide poetry

As we contemplate the new year ahead, I sometimes find poetry does a much better job at summarizing the intangible. Here is a good one for contemplation. I first heard this poem this May when it was read at our nurse pinning ceremony. Simple and to the point. I hope you enjoy it too.

Life

Life is an opportunity, benefit from it.

Life is beauty, admire it.

Life is bliss, taste it.

Life is a dream, realize it.

Life is a challenge, meet it.

Life is a duty, complete it.

Life is a game, play it.

Life is costly, care for it.

Life is wealth, keep it.

Life is love, enjoy it.

Life is mystery, know it.

Life is a promise, fulfill it.

Life is sorrow, overcome it.

Life is a song, sing it.

Life is a struggle, accept it.

Life is tragedy, confront it.

Life is an adventure, dare it.

Life is luck, make it.

Life is too precious, do not destroy it.

Life is life, fight for it.

written by Mother Teresa

Defeating unfairness in a quote

In the midst of packing I have found myself reading an odd book for my tastes - really I just downloaded it from the library since it was ready in the 2GoCart option and my other books are still on hold. It sounded strangely calming in the rush of packing boxes and squeezing in last minute coffee dates with all my beloved friends and keeping my tears under control as I said goodbyes. The book is called The Best Advice I Ever Got: Lessons from Extraordinary Lives by Katie Couric. Each chapter is from a different person she has interviewed. As I am a sucker for a meaningful quote, I found this one quite powerful.

"Indeed, life isn't fair...despite this obvious fault in the universe, it cannot be used as an excuse for not trying to be your best self. Instead, use unfairness as a starting point to be sure than your actions are the best you can muster, and find peace in navigating your time here with grace and humor whenever possible." - Valerie Plame, former US CIA Operations Officer 

Growing up in my household I heard the constant refrain from my stepfather that "life isn't fair - get used to it."  (Note: let me be clear, my stepdad is wonderful, he just was trying to prepare his children for this harsh reality). At the tender ages of childhood I often felt like I was the only child of divorced parents in our small town and in retrospect I wish someone had clarified what you are supposed to do when you have that realization that unfairness is the norm. Plame's quote gives the solution to that adage of how to deal with unfairness in an articulate,succinct manner that is also inspiring.

This quotation also hits me in my nursing heart. Already in clinical rotations I have seen the patients with terminal illnesses that are kind, compassionate people that face their mortality bravely and still some how carry a smile. All you think is that it's just not fair and it tugs at your emotions. It is a reminder that grace and humor are tools just as important as your stethoscope and alcohol wipes that we carry onto our unit with each day.