Posts by Wanderer

I read, I write, I ride. They say "life is too short to drink cheap beer." Guess my life is gonna' be really short.

Traveling Truths

Some say that to truly understand this world, one needs to travel it.  And while Georgia (the state) is not that far away, it really is a different place than I’m used to.  But the refrain stays the same: people are good and decent at heart – for the most part, no matter where you go.

Going from a small town, seriously, we’re small, to a much, much bigger city like Atlanta is jarring to say the least.  Drive 45 minutes in my town and you can almost be in New Mexico.  45 minutes here and I’m barely into the suburbs.  The decidedly un-pedestrian friendly suburbs.  And bike friendly?  It’s stretch to call what is painted on the streets a bike lane.  But that doesn’t matter.  Everywhere I go  people have been polite, friendly, willing to help an overwhelmed traveler and that’s been really nice.  It’s made the shock of transition much easier.  Mostly.  Kind of.

Traveling for work is not something I ever want to do full time, I’m truly too much of a homebody.  Maybe living in a small town is actually bad for me, it has distilled the fear of the unknown, the fear of being in a much larger place, into something bigger, more oppressive, something I never truly felt before.  That feeling alone is almost enough to make me want to leave the comfortable confines of my small meager existence, but only just.

The growing reality is that I’m actually content there.  I won’t say happy, because happy is a fleeting momentary glimpse of something unattainable, but content is just about right.  Being away makes me realize that feeling is true, not just some lie I’ve been telling myself for years to make moving to a small town easier on myself.  Leaving the comforting cocoon is good – it makes coming back that much better.  It’s the understanding of that perspective that is really good for me.  Aside from that my wife and I both realize that we need to try to stretch out more again, to go do things, not stay sequestered in our small mountain retreat so that we don’t grow small, scared of the outside world like so many of our neighbors.  The traveling truth is that you can stay the same and risk being passed by or change like crazy and risk losing your grounded-ness.  Finding the middle way is the essential.

Oh yeah, I learned a metric shit ton of stuff about building rules in our EMR.  That was cool.

Saying Goodbye.

A little over 2 weeks ago we laid my little brother to rest.  After 36 years of living with 15% (give or take) of a normal lung capacity he finally has the relief and release of not having to struggle anymore.No more fighting to breathe.  No more yards of oxygen tubing trailing him.  No more having to breathe through a trach.  Finally free.

The enormity of the impact he had on my life can’t be adequately measured.  Nor the scale of impact on the hundreds, possibly thousands of lives he touched in one shape or another.  Unique is beyond description.  Missed is the true reality.

He and his brother were born too early in early 1980.  Back before artificial pulmonary surfactant, back before many of the advances that modern medicine has discovered in the care for those born too early, back before they really knew or hoped for better outcomes for preemies.  The wise doctors gave them a 50/50 chance to make 6 weeks.  He made it 36 years and every time the wise doctors said he wouldn’t make it since, he turned around, grinned and proved them wrong.  It wasn’t the age though that got him in the end, it was the mileage.  Imagine going through life always needing something, oxygen, a ventilator, to help you breathe; it must have been terrifying and frustrating.  Being able to interact with the world, but not truly able to fully engage with it.  That was my brother.  God knows he tried though.  Tried to live his life as best he could, as he knew it, by his terms if he could.

Some have asked me how strange it must have been for me to have him as a brother.  But it wasn’t: his limitations were the normal, we were used to living within them.  Looking back it is strange to think of 10 year old me changing his trach when he accidentally pulled it out, but at that moment it wasn’t.  Any wonder I ended up becoming a nurse!

Strange is now realizing that when we go back to Seattle to visit my family we won’t be making that side trip to visit him.  To come around the corner at his house to see him sitting on his exercise ball at his computer and then looking up at us like we were weird for being there.  But grinning at us when he realized that we were there for him.  That grin was infectious.  It was rare in the last couple of years as the mileage added up, but it would come out and light up a room.

He had been on hospice the last year of his life and by proxy I became my parents’ medical adviser when it came to what was going on.  I shared in the agonizing decisions in the last year, made almost worse by my distance.  Luckily they had very clear ideas on what they believed was the best course for him – and I would like to believe that he shared that idea too, even if he couldn’t express it beyond asking for the pain to go away.  Finally he was granted that wish, early on a beautiful Sunday morning he passed away peacefully in his sleep, in his home.  There was grief, leavened by a touch of relief that he was in a better place now.

It’s said that you can tell a lot about a person by the amount of people that show up for the memorial.  In his case it was true.  The amount of people who came to support our family was staggering.  It was cross-section of the people in our lives from day one.  There were nurses who had cared for him 36 years ago to the current day and plenty of family who came to mourn the young man they knew so well plus people from random-ish encounters, people whose lives he had touched, either directly or indirectly in some fashion.  Thinking about it now still impresses me.

Above I said that it was any wonder I became a nurse.  That rings beyond true.  Considering I could change a vent circuit early on it’s a surprise I didn’t become a respiratory therapist instead, but a nurse I became.  They say every nurse has a fluid they can’t deal with, for some it’s melena, some peritoneal fluids, for me it’s renal failure urine, but for many it’s lung butter – something thanks to my childhood has never been a problem for me.  And that’s the least of the things he taught me allowing me to impact lives far beyond him.  If things had been different, if he and his twin had been the little girl my parents were hoping for, obviously things would have been different, but there’s a deeper level to that beyond pure genetics and twists of fate.  He taught me so many things like compassion for the different, empathy for the sick, without even trying, just by living and being my brother.  For that I’m beyond grateful.

He’s gone now.  But he left a legacy a mile wide.  Thanks to President Reagan (perhaps the only time I’ll say something like that) who signed into law a change to Social Security that allowed him and others like him to leave the confines of institutions and go home, something that happens as part of regular happenstance now.  He was the 6th individual to do this in the entire nation and the 1st to do so in Washington state.  The fact that a medically fragile child, dependent on a ventilator and oxygen, requiring skilled nursing care could come home was proved by cases like his.  He came home and the wise doctors expected him to die but instead he thrived.  Once again proving them wrong.  That was what he did, confound, teach, touch and make you better for having known him.

And that’s why I love him.  And why I miss him.  And will never forget him.

I’m ALIVE!

Still alive, still kicking and actually feeling like writing again.  Weird, right?  Take a 3 year…yes 3+ year hiatus from a blog and see what happens.  Nothing really.  It just kind of sat here, growing moss.  For some reason I couldn’t write.  I found other things to do.  Most of my writing came in 140 character chunks.  So…

When we last left our intrepid adventurer he had just finished a year living in a new town, new job, new hobbies and new challenges.  So what’s changed?  A lot.

I have a new job.  A new bike.  A new lifestyle (would you call changing one’s diet a lifestyle?).  A new outlook on life.

Part of this resurgence involved me reading some of my old posts: I really wasn’t happy was I?  Change can completely alter your outlook on life but sometimes it takes awhile for those changes to stick and become the new normal.  I’m not saying it’s all unicorns and rainbows, but in the grand scheme of things I’m content.  Happy even.  Luckily I’m still just as sarcastic, but the cynicism has mellowed.

It’s been 4 years since we left Portland.  Four years to find myself again, find my passion in nursing again, find that the world truly isn’t the terrible dark place I thought it was anymore (granted,that’s debatable).  While I’m not saying the glass is half-full now, I can admit that there is a glass.

Here’s to hoping I don’t wait another 3 years to post again.

Meditation on 2 Wheels

I’m grinding up a steep hill on my bike. Quads are burning, breathing is ragged, the sun baked pavement stretches up ahead of me, taunting me in an inexorable gradient as sweat drips off my nose.

I’m focused, single minded in my intent. Nothing else clouds my mind except the turn of the pedals. The thoughts that woke me too early on this weekend morning forgotten, washed away by the wind on my face, burned away by the pain in my legs as I start another hill. It’s meditation on two wheels. It’s just what I needed.

A Year Later

It was a year ago 2/27 that I worked my last shift at the bedside. I was burned out, didn’t care anymore and looking for a change but couldn’t get motivated to make one. Taking a voluntary lay off was one of the best decisions on my career.

A year ago I dreaded going to work, dreaded dealing with the unstable mess I felt my unit had become and sick of dealing with the overwhelmingness of not caring. I cared about my patients but didn’t “care” about them. Maybe I allowed myself to get too close, didn’t keep and extend enough professional distance to not feel burdened by their issues. Whatever it was, I was not healthy, mentally or physically.

In the last 6 months I worked in Portland I began developing serious anxiety issues. I had never experienced an anxiety attack, but when the first one hit and I sat there vibrating like a guitar string, hyperventilating, freaking out over going back to work I knew something was not right. I was crass, callous, more cynical than normal. Short and rude with co-workers and unable to maintain the Zen-like ease that I had previously, I needed something different.

Different I got. Moving from a teaching facility to a small community hospital. Changing from bedside nursing to compliance and charge capture nursing (clipboard nursing…). Moving from a city to a small rural community. Going from 9 months of gray skies to abundant blue skies and sun. It’s like getting my life back. I’ve lost weight, learned to sleep normally again and rekindled that spark with my wife. Life, for the most part, is good. It took 5 years of death by a thousand cuts to nearly destroy me, luckily it only took a year to heal me.

And now I sit on my porch, blue skies over my shoulder, feeling the sun on my back and know it’s been worth it.

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Like a punch to the gut.

My wife and I were hanging out own the couch, chatting about a variety of topics from a local townhall on Agenda 21, gun control and what color of laminate flooring would look nice in our entry hallway and we looked over to see our two cats lazily lounging in each’s favorite spot bathing. They were so content, lulled into peaceful complacency by our dreams, our conversation and our simple quiet life. She said, “look at them, contented and happy” with a sad smile.

That’s when it hit me, like a sucker punch right in the gut: we had said that about our daughter. When they (my wife and daughter) were in the hospital we had a nightly ritual. The floor that my wife was on listed visiting hours at 9pm which meant I had to leave but since our daughter was in the NICU they would allow us stay visit as we wanted. So we would go and sit in her little room say hi to our little fighter and talk about our dreams, hopes and plans, just like we had while she was in the womb. Her nurses would always comment that before we got there things would be a little out of whack, a little agitated, working against the vent a bit, but as soon as we got there she’d calm down, eased into peace by our presence. They would then step out to give our little family time to be just that. Even with lines and tubes coming out of her little body she was peaceful when we were there. It is some of my best memories of her.

I realized my eyes had welled up and I saw tears in my wife’s eyes too. Even though it’s been over 6 years since she was born and we experienced something I wouldn’t wish on anyone and even when I think that I’ve healed from it, something comes along to remind me (us). If she was alive today I can’t begin to imagine how different our life would be. Luckily we still have our memories and even though they hurt sometimes, it’s nice to have them.

Burned Out Nurse, or the new Typhoid Mary?

According to a recent survey, burned out nurses are more likely to spread infections. Here’s all the gory details: Burned-out Nurses linked to more infections in patients.

Having been a burned out nurse, I can see where this might happen. You’re tired, you’re pushed daily to give care to sicker and sicker patients and there’s more of them. Those of us who have tread that road know that it is not an intentional thing. These are small mistakes made through inattention, missed attention, attention focused on too many other things, complications of being pulled 7 ways at once that being a bedside nurse in inherent to.

But according to many comments left on the article, nurses are lazy and sit around all the time, it is all a conspiracy by the Man to keep the proletariat down, that being abused is part of the job, that we should just get over it and do our job correctly or get out of the profession. Very few voices of reason rang out, but this is the Internet and trolls abound. No one really gets it.

There is little to discuss why burnout happens or what our employers can do to help with burn out except for a short superficial look at staffing ratios. Unfortunately, staffing ratios are not a panacea, they are a means to an end, but unless coupled to acuity it is meaningless. Too often the cause is that there is too fluid of a patient population with huge swings in census, that hospital profits and administrator salaries are put ahead of nursing staffing, that reimbursement for many stays is a joke and that our patients are sicker than before.

There is hope though as the article mentions that when burnout symptoms ease, rates of infection go down. This highlights the obvious: happy nurses are nurses who can deliver the best care. Simple really. Too bad the things that would make many happy are the things that hospitals themselves would never realize. Instead they will continue to bury nurses under a blizzard of pointless paperwork, poor staffing, sicker patients, poorer compensation and even poorer support from those above in the hierarchy. We need though to learn as nurses how to keep us from transforming into Typhoid Mary even though we might be burned out and understanding of what can happen is the first step.