Sunny Summer with no Snow in Sight!

The giraffe stared at us benignly as we drove by, gawking tourists with flashing boxes. You can almost see it smirk, thinking "crazy short-necks." Nevertheless, it was quite exciting to be on an African Safari in the middle of San Diego California.

Here we are taking a much needed break after a long day walking through "Africa"

Our names written in the sand The last time you'll see my pirate headband..sigh...a roller coaster snatched it awayOur signature pose when you don't have a photographer with you, thank goodness for long arms!
I forgot that with my new computer I could actually post pictures. Which means I don't have to write as imaginatively anymore, because pictures are worth a thousand words, right? I thought I'd add some sunny perspectives since my last post was about snow. I love summer!

SNOW!!!!!!

This post is not for creative writing/juice flowing purposes. It is simply to yell at the world: I HATE SNOW IN APRIL!!
There, it's out. But I don't feel much better. This morning I woke up and the wind was howling. I rummaged out my winter coat that I had gleefully put away. I trudged through the bitterness to the bustop. I heaved huge sighs of woe all day at work because every time I looked out the window all I could see was white and wind. It was very depressing. We all felt it. Even our patients. All in all it was a very sad day, and now I'm going to go crawl under my warm covers and dream about a real April with showers and flowers rather than snow.. and.... dead flowers.

Why I can't Pee

Now, don't worry. There is nothing wrong with my urinary system. But my mother, and others, are having a hard time understanding why I find it difficult to use the restroom more than once in a twelve hour shift. This is like asking why a basketball player doesn't have time to eat tea and crumpets during a game. Or why a marathon runner doesn’t have time to play a game of chess during a race. It just isn't possible.
Let me try to map it out.
6:00am - Alarm goes off. Depending on how tired I feel, I may or may not hit snooze... more than once.
6:30am - I trek to the bus stop in the dark (before daylight saving. after we can see the first tint of dawn)
6:36 - My bus comes. It should be more like 6:38 because it's always late.
6:50 - I arrive at the hospital. I join the general melancholy trudge of traffic as we make our way into the building.
7:00 - I get report from the off-going shift. Depending who is giving report and if I've had any of these patients before, it can take 30-45 minutes.
7:30 - I plan my route of attack on my unsuspecting victims...I mean patients. Depending if I work on the floor or in the ICU that route can differ greatly. We'll go with the ICU today.
8:00-8:55 - I usually have two very sick patients, both intubated (breathing tube), needing neuro checks every hour. This means every hour I literally have to yell at my patient to show me two fingers, or a thumb up, or a wiggle of a toe. Level of consciousness is what we’re looking for, and often, neuro checks can take 20-30 minutes each, if sedation needs to be turned off and they're slow to respond.
Then there's full body assessment, heart, lungs, stomach, etc.
Then it’s time to get morning meds, which invariably all need to be crushed and flushed down an NG (nasogastric) tube. This also can be time consuming, as each patient has 15 meds in the morning. And IV drips. And injections. And eye drops.
Then there is the writing down of the vital signs, which is usually every hour for both patients as well. Heart rate, temperature, respiratory rate, pulse ox, blood pressure (by cuff and arterial line), intercranial pressure and cerebral perfusion pressure are the main ones. Sometimes depending what they're in for, other things are monitored.
Also, depending on what type of drips their on, or a special parameter the doctors want followed, I’ll have to draw blood every 4 hours or so.
The first morning hour usually flies by.
9:00am - Vital Signs and Neuro checks all over again. Sometimes more meds.
9:30am - Sign off orders, look at labs, usually something comes up that I need to call the doctors for.
10:00am - Starts again. Oh, and every even hour I have to measure how much fluid I've given the patient, and how much they've gotten rid to make sure they're not getting too much or too little. I also forgot to mention that every even hour (at the very least) we must reposition the patient to prevent bedsores. (Our unit rocks at this, by the way) Not to mention oral cares. If a patient’s mouth isn’t cleaned frequently the risk of pneumonia increases.
11:00am - Okay you say, you probably could've gone to the bathroom around 10:30ish, right? Well, I reply, you're right, I probably could. But you're assuming that everything is hunky dory. But between the hours of 10-11am is where everything, inevitably, starts going downhill.
It's called the dreaded: NEURO STATUS CHANGE.
This cascades into a series of events that always leads to a stat head CT. ALWAYS. And, just last week, it happened to both of my patients, AT THE SAME TIME. This is every nurse's worst nightmare. It's okay if just one of your patients is having issues. But both at the same time makes you want to scream. Or at least get really flushed in the face. Luckily, we work as a team in Neuro Land. One nurse takes one patient, I take the other, and we have a race downstairs.
This is called: A ROAD TRIP.
These are not the breeze blowing in your hair, sun beating on your skin, sunglass-wearing types of road trips. This is a scramble around madly, unhook a bazillion cords from the stationary monitor and plug them into the portable monitor. Call respiratory to bring their portable ventilator. Bring the IV pole with the bazillion drips and cram it all into the tiniest elevator possible (that they claimed to have enlarged for us) type of road trip. The scan itself takes approximately 2 minutes. I'm not exaggerating! But to get down there and then back up usually takes an hour. And you're just praying nothing bad has happened, that you don't have to tell the family their loved one has just gone to the OR, or they've stroked again, or any of the numerous things that could cause a neuro status change.
So it's 12:00pm now. Maybe later. Depending on what went wrong during the 10am-11am hours of doom, you're either way, way behind with no hope of a potty break until kingdom comes, or you foresee a potty break at least before the angels start trumpeting. Don't forget, you have to chart absolutely everything. "Chart like you're going to court" is a favorite saying of ours.
1:30pm (or 1330 in military time) - I usually get to go to lunch. During which, I get to use the bathroom. Technically we get half an hour, but if I want to catch my 7:36pm bus on time, I really don't want to be gone that long.
2:00pm (1400) - It all starts again.
3:00pm (1500) - And again
4:00pm (1600) - Usually the time when lots more meds pop up. And when family starts to visit. This is usually my favorite part. It does tend to take up lots of time to talk with family and explain things to them, but if I can make things any easier for them, I'll take that time.
5:00pm (1700) - The homeward stretch, usually. Sometimes it's the "Holy Guac-the-moly, I only have two hours to get all this done!"
6:00pm (1800) - The final reposition of the night. If I’m lucky there won't be any little "surprises" under the patient, but one never knows. With all the medications and tube feeding we give these poor people, we either put them into a constipation or a diarrhea mode. Never a happy medium.
7:00pm (1900) - The on-coming shift arrives. Depending on whether they've had the patients or not, report can take anywhere from 30-45 minutes. And then I’m free! Unless I have last minute charting to do, which is often the case.
7:35pm (1935) - I'm running for the bus stop. If I'm lucky, the bus is late. But the bus is never late going home, unless I'm late getting to the bus stop. At least it seems to be the case. But let’s just assume for this little literary exercise, I get to the bus on time. It's crowded with weary workers such as me, but I can usually find a seat.
8:00pm (2000) - I trek back to my apartment in the dark, even with daylight saving. I take a shower, scrubbing off the hospital scum I know to be covered in.
9:00pm (2100) - I might waste a few moments on the computer or read a little to unwind.
10:00pm (2200)- I make sure my alarm is set. I am asleep before my head hits the pillow.

Loss

I think if I thought more about what happens at work, I'd never be able to go back. So I numb myself. I distance myself. These are the tasks I must accomplish, I must keep this person alive, I must keep them clean and comfortable, I must be pleasant and calm when inward I'm seething, I must know the whys and the what’s behind every task. I do this very well.
Yet, I had this beautiful, noble purpose about becoming a nurse. I could help families through the same struggles. I'm one of the few who can say, "I know what you're going through. Really."
But I just can't make myself that emotionally available. I can't. I thought working where I'm working would promote healing, give closure. All I've done is replace old feelings with newer ones. Horrible memories with less horrible. So there it is. And here I am. Stuck. I do my job, I do my duty, but was I able to ease the pain?
I can't even remember, except small snippets, the pain I went through, my family went through. I almost feel brainwashed. I've almost erased this huge experience. And when I try to bring back those memories I mentally cringe and can't bring myself to do it. So, I go through the motions of my day, I do my work very well, but if I ever once try to go back and put myself in their shoes I hit a wall.

Needles

I hate needles. With a passion. The first time I went to Mongolia I had to get five different vaccinations. The last one made me pass out. Sharp pointy thing overload. I still donate blood, though the grimaces on my face makes the phlebotomist nervous. "Are you sure you’re okay?” and “Do you need some water?" and "Are you going to pass out on me?" is the final question they usually ask as I scrunch my eyes up and probably turn deathly pale. I can't help it. It's the fight or flight response in over-drive. However, I have no problem putting sharp pointy things in other people. Yet, I can definitely empathize with the look of panic that crosses my patient's face before I make the plunge into their skin.
Why all this sharp talk? Well, today I received the most beautiful TB skin test and flu vaccine ever. I was lucky number 300th poke, so this lady was a pro. I didn't feel a single thing. Usually when I get a TB skin test, I end up with a ginormous bruise on my forearm within a matter of minutes. This time... nothing. My deltoid usually aches for days on end after a flu shot. This time? Nothing! I'm as surprised as you are. I didn't even flinch. Maybe I’m conquering my fears after all. Or maybe I just need to be number 300 more often.

To market, to market...

I went to the farmer's market with my friend after work this morning. I love the farmer's market. It's what living in this semi-big city is all about. On every corner, you’ll see a different musician or street player, from a classical violin to bongos on a bench, trying to outplay each other, but creating a pleasant mixture of sound together. Among the noise floats the aroma of freshly baked cinnamon roles and the smell of earthy-ness from the various veggies and herbs in mouth-watering arrangements. Calls from vendors that were perfected in the days of Newsies also vie for attention. Food for the stomach: "get your warm, hot, spicy cheese bread over here, fresh from the oven!" and food for the soul: "get your peace, everlasting peace over here!"
I love this open market atmosphere and the good-natured heckling and banter you can eavesdrop on between booths. The one thing that's different in this open market than from other open markets around the world is that there are fixed prices. No haggling over how much you're going to pay for a pound of spinach. (Though you can pretty much be handed the I-swear-it's-safe-spinach free these days.) Don't get me wrong, the prices are more than reasonable, but sometimes it's fun to barter. Though I'm very much a softy, so I'm the sucker most vendors would pray for. It’s mostly just the remnants of Mongolia speaking now.
After walking around the square twice, I decided on some beef jerky, grape tomatoes, raspberries, sunflowers and these weird magenta flowers that look like coral from the ocean. I have no idea what they’re called, but I had to get them because they’re the coolest looking plants I’ve ever seen. I should also mention I got some green beans, green peppers, pears, apples and cheese curds. As you can see, I just randomly grabbed things that appealed to me. That’s my favorite type shopping, just spontaneous buys rather than an agenda. And the market is the perfect venue for that. Especially after working all night and everything begins to look blurry in the daylight. Now I’m off to eat some raspberries and cream. Well, raspberries and skim milk… but that’s almost the same… right?

Found

My journal that is. One word: yay! With my personal rantings, outpourings of angst and the odd dream or two, I'm sure if offered some interesting summer reading to the people who happened upon it. But as long as I never have to meet them, I'm totally okay with strangers reading (and most likely laughing about) my innermost thoughts. I had just resigned myself to never seeing my beloved book of candor again, and was starting afresh when my mom told me it had been discovered and was now racing its way in the mail to my house. Again: yay! Now I can write my most intense feelings into a book with a front and back cover, feel the pen flow across the page, and write about the more trivial things on my blog. Finally: yay!

Messed Up

I am completely messed up. Well, let me rephrase that, I am completely messed up sleep wise. But maybe I'm just completely messed up too. I wouldn't doubt it. Last night I had off from work, and usually it's no problem for me to stay awake all night and then sleep all day in order to prepare for work the next night. But last night I totally closed my eyes on the couch, knowing full well it would come to no good, and sure enough five in the morning rolls around and I wake up. Instead of prepearing for bed, like I should have been doing. So I'm messed up. Now it's one in the afternoon and I'm wide awake. Luckily I don't have to work until 11pm tonight, or 2300 in good 'ol military time. So there might be a moment or two for napping later this evening. I think I'm going to go and enjoy the sun, in the middle of the day, which is something I rarely get a chance to do. This might not be such a bad turn of affairs after all.

In light of previous post...

Your Famous Last Words Will Be:

"I can pass this guy."

What Will Your Famous Last Words Be?

Sirens, Lights, Ticket!

Okay, before everyone starts cheering about this because, I, a well known speeder and escaper of tickets, finally got one, let me explain the inhumanity of it all. I'm not one bit repentant. Well, maybe a little. But definitely not a lot. All the other times I've been pulled over, if I HAD received a ticket, I would have nodded acceptance to my obvious guilt and taken it without a single iota of resentment. The police officers, in their graciousness, deemed me to either be
1. a learner from my mistakes
2. a nurse who should know better
3. a really sad, pathetic little girl, who needs to drive away fast before I get really annoyed with her crying
4. an offence worthy of a written warning only OR
5. to have such a good record, it would be a shame to mar it with a ticket.
Yup, I think that's all of them. But this time was different. This time I was not speeding. Technically. In my own opinion.
I was in a 55mph speed zone, I'll admit it. But I could SEE the 65mph speed sign in front of me. So I felt at liberty to increase my speed. And of course, RIGHT before I reach the 65mph sign, a police officer, just waiting for it's speeding prey, pounces like a chimpanzee on a cheeto. There was no pleasant banter, no small talk like I had grown accustomed to. It was all business. This was because he knew it was a cheap trick and wanted to get me out of there as soon as possible because he was so shamefaced. It was written in his every move. Or perhaps he just wanted to get back quickly to his same sneaky position and catch another unsuspecting bug in his venous fly trap.
I have my ticket, and I'll pay my dues, but there is no way I'll feel contrite about this one! Um...but it's made me a safer driver. And better observer for stationary squad cars.

Return

I'm back from Mongolia.
I'm not sure how I feel about that.
People ask me how my time was, and say it must have been so much fun. But that's not how I would describe it. It had its fun moments, but it definitely wasn't fun. It had its exhilarating moments, but I wouldn't fully describe it that way either. There were time-to-go-back-to-America moments, and I-wish-I-could-stay-here-forever moments. Emotionally grueling moments, physically trying moments. God ordained, Holy Spirit filled moments.
I try to explain these things to my family, my friends, my co-workers. It's like trying to describe a sunset to a blind person. You can tell them about all the brilliant shades of colors, but unless you actually see it, unless you are actually there, you will never fully understand the immense experience of it all. But of course, that will never keep me from trying to use all my descriptive ability to impress upon my audience how two weeks can have such a lasting impact on life.

Theological Talks

I'm back from working my "princess shift" a four hour filler shift from 7pm to 11pm. Don't ask me why I have to work this ridiculous period of time, I just suck it up and do it. But now I have a long empty, sleepless night stretching out before me and so I thought I'd bare my soul on my blog because I don't have my journal. Yes, I know I could start a new one, but I'm still holding out hope that it will be found in the near future. Hopefully. I hope. Really, really hope. A lot. A lot of hoping. Sniff.
Last night I had a very long talk with a fellow co-worker about my Christian beliefs. It was, in fact, a three-hour conversation. (It was a slow night, what can I say?) It provided the opportunity for basically everyone in the ICU to hear about my devotion to Christ. Our debate ranged everywhere, from creation vs. evolution to the divinely inspired word of God vs. a book written by a bunch of drunk men to heaven and hell vs. ascending into another plane of existence to God's sovereignty in suffering vs. happenstance to Predestination vs. Free Will, we're talking some very heavy issues here.
The majority of instances when I have these types of conversations I am always so afraid. Afraid of what other people will think of my stance, afraid of being shunned by friends, afraid of saying the wrong thing, afraid of not knowing what to say. Last night I was bold in my conversation, I was always able to answer his questions (not to his satisfaction of course) but it didn't matter. Scripture I had just read the other day was coming to me right when I needed it (albeit I discovered I miss-quoted once, after I rehashed the conversation out with my father.) But still, I'm not discouraged. Do I have it all together? Of course not. Can I convert someone with my own silver tongue? Of course not. But what I loved the most about this experience is that the reason I didn't care what anyone thought of me was because I was filled with an inexpressible joy for my Savior, and I wanted to tell him about it. It overflowed out of me! It was the most amazing thing... may it always be like this, that I would be forever emboldened to share the Good News of Great Joy to all who will listen, and to those who listen, Lord, help them believe!

Responsibilities

This is something I would most likely write about in my unrecovered journal which I'm still crying on the inside about, and venting on the outside about. Anyway, my parents have changed their will and made me their POA's and given me custody of any minors if they die. Even though I'm surrounded by death often, and I glory in death because it brings us face to face with our Savior, I still don't like to think about my parent's dying. And that I might have some say in that. All the time I see families torn because the person who is the POA wants to do one thing while people who don't have the final say in the decision making are trying to persuade the POA do something else. It's heart breaking for families. It's heart breaking to watch even. There are so many variables when it comes to keeping someone alive and when it's time to withdraw care. I know how my dad feels and I know how my mom feels but it's not always so cut and dry when you're faced with a real scenario. But, it is something useless to worry about, and it shows my lack of faith in Christ. I'm not saying it'll never happen, but these are choices I don't have to make on my own, Christ's strength and comfort will fortify me. I'm not being dismissive of the responsibility, or even fatalistic, but I know with great certainty that I don't need to worry about that bridge until I come to it. May "the peace of God which transcends all understanding guard my heart and my mind in Christ Jesus" Philippians 4:7.

Lost

No...not the tv show, but something very near and dear to me. My journal!! Sure blogging has it's moments, but the hand-written word can be so much more satisfying at times. Not that my handwriting is gorgeous or anything, or even legible for that matter (unless on legal documents;). But when I'm in a real rage, or despair, or any extreme mood, flying over paper with a pen is definitely more therapeutic than that tappity-tap of the keyboard. My poor, poor journal....sniff. It had so many personal stories in there, plus some of my best dreams were recorded there...it feels like I lost a little part of me. Or maybe a big part of me. I'm sure I'll get over it but for now I need to find a piece of paper to scrawl my angst across.

Symptoms

Just once I want the doctors to actually be concerned about what I am concerned about, when I am concerned about it. Last night my patient became tachypnic (pronounced "tah-kip-nic", a word that's more fun to use instead of "rapidly breathing") and tachycardic (also a superb replacement for a racing heart). Using these big medical terms I was sure would reach to the brain of the neurosurgeon. My mind is already rapidly racing (um..tachycerebral?) through all the possibilities (or differential diagnosis). PE? Mucous plug? MI? Well, as is always the case, the Doc comes to check my patient out and all of a sudden these symptoms resolve. I swear, this happens to me all the time!! So, because he didn't witness it then it's not a big deal. Well, when the team came to round in the morning I did describe my little episode (well, the pt's episode, not mine...I'm more professional than that. I had my episode at home.) These symptoms seemed to stump even the team, even while using their collective brain powers. Then tests were ordered just to rule out any of the aforementioned conditions. I am however glad it was stumping the MDs and not just myself. Is this trivial of me? Most likely, that's why I love medicine so much, so many mysteries...

Dreams...?

Now that it's daylight, I'm trying to figure out if what happened last night actually happened. This occurs occasionally while working the night shift...it's almost like you're in a surreal state with a foggy sense of reality. You're body is telling you over and over again you should be sleeping and dreaming, and so sometimes what happens over the night feels like a dream. I was sitting at my station, minding my own business, writing some numbers down, prioritizing for the rest of my shift. Then a fellow (male) co-worker comes up to me. I give him a glance and ask “what's up?” He says to me, "let me preclude this comment I'm about to make by saying it's not a come-on or anything." "ooookay" I respond, not quite sure what this is about.
"I have to tell you, you are absolutely gorgeous."
Ummm, even with the scaly skin, bags under my eyes and stylish scrubs?
"Well, thank you very much," I manage to get out. I would not have expected this comment from this particular co-worker. I'm a bit stunned.
"I wanted to tell you yesterday, I thought you should know." He walks away. Um...
"It's a good thing you started this conversation out the way you did, or I would've wondered," I quip, trying to make light of a situation that's very quickly making me feel very awkward. He laughs, I laugh and then no more is said about the matter.
Yet, it's amazing how a compliment like that can make you feel. I have to say I was flattered, a little creeped out, but still flattered. And my mom thinks I should curl my hair for work! Imagine the comments I might get then....

Cooking 101

Eggs are definitely an important part of a brownie recipe. Salt...you can most likely do without. Vanilla too, if you're really hard up. But eggs, well, eggs are very necessary. Otherwise you're left with something that is trying really hard to resemble brownies, but looks and tastes more like chocolate sand. And not very good chocolate sand either. So let this be a lesson to you all, if you're going to make brownies, and you're going to forget an ingredient, make sure it's not the eggs.

Skin

I think my skin is confused with my new schedule. Since I'm awake mostly when it's dark out, and winter is usually dark, my skin believes it is winter. And thus, my eczema is slowly turning me into the lizard lady. Seriously, I could be part of the freak show at the circus. I am a scaly beast. Normally, summer humidity soothes the skin, it's the dry winter that cracks the already dry parts and I start flaking my own snow everywhere. Now, both of my inner elbow creases, my temples, my right cheek (facial), the back of my neck, my left eyelid...all have scales. I was reading a book about these people who associated with dragons and because of that contact started growing scales themselves. That's how I feel. Except these aren't "bejeweled scales that glisten in the sun", these are white and flaky patches that shed in the sun. Time to crank out the thick as butter hand cream and slather it on. I will not let it get the best of me! Did I mention my hands are scaly and nasty too? There is no hope...

Silver Linings

Erg. I did not sleep very well today, it was too sunny, and people, who shall remain nameless, kept calling me...on purpose. (I can sense your gasps of astonishment, but it's true!) What’s even worse is by the time I get adjusted to the night routine again I'm going to have to switch back over to days. Ah well, such is life. Work was intense last night, or I should say this morning. My patient started emitting bright red blood from his OG tube, it completely freaked me out. Of course, I kept my calm and did the necessary things and everything turned out okay, but I always get scared around GI bleeds. Another one of my patients a while back had a massive GI bleed, dropped his pressures to 80/40 even with vasoactive drips. Pretty scary stuff. Emergent surgery and all that.
But the title of this entry is silver linings. So I should start with the good stuff. Emergent surgery guy is home with his family doing fine. My current patient was stable when I left, always good news. Now I must expose my materialistic side and admit the other silver lining is I made a mistake on my taxes but the IRS fixed it and I get a bigger tax return. Whoohoo!..ahem, I mean, that's nice. Also, I was able to get vacation days so I can go on my family's annual Door County excursion for five days. YAY! Finally, I'll be working straight nights for a straight month, which means an end to the flip-flopping for a time. Life may not always be good, but I'm fairly content at the moment.

Confession

I have a confession to make. I love to look inside people's cars and imagine what sort of lives are exhibited there. For instance, there is a silver car (I'm a girl, I don't pay attention to make and model) that parks next me in the parking garage. I had just pinpointed this person to be a hockey player slob. The bags of chips strewn across the front seat plus the mounds of hockey gear in the back gave it away. Then yesterday evening as I gave a cursory glance in the back end of his car I was confusingly surprised. Sheet music! What kind of hockey bum was this? Stacks of sheet music now served as a coating for the hockey gear. Was he transporting it as a favor? Or did my conception of him need to be radically reassessed? Yes, I do believe this is a musically talented hockey slob. So driver's beware. What you leave in your car may lead me to make assumptions about you, true or otherwise.