Author: Tribal Queen

Navigating the world, attempting authentic love of everyone I encounter, and breathing in as much of the world as possible before I leave its beauty.

Notre Dame Burns and I Can’t Cry

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I find myself more and more utilitarian in my life. It started with food. I eat the protein and the carbs so I can keep functioning at work. Then it seeped into my home. I don’t cook for the joy of it any more. I cook to feed my body.

I’ve become more minimalist in my home life. Half of my apartment has been donated or sold in the last 6 months. My excuse for this is blame on my ex. When Jake and I lived together, he was anything but a minimalist. Quality, the best of the best, the latest thing, had to fill up our apartment. So we did. We filled this two bedroom to the brim with junk we didn’t need. I don’t know about him, but I didn’t want it either. It was just another red flag, trying to fill the void of a lousy, empty relationship. I use this excuse, and the idea that as a single woman with a cat, I have no need for a two bedroom apartment. I am donating or selling the majority of my books. My books! This girl who used to live by the motto: “A room without books is like a body without a soul.” I sold my record collection when my record player broke beyond repair. Saying to myself, “You can save money if you move into a studio apartment.” Some call it “downgrading,” but I’m starting to see it seep into my joy, or allow my joy to seep out. I’m not sure which.

My Instagram is almost nonexistent and I made that choice deliberately. The anxiety of posting regularly enough, of gaining followers, of constantly showing the great part of life, of seeming happy all the time, the fakeness of it all, was exhausting and painful. But one thing I’ve noticed since then is that my view of beauty has become altered. It too has become utilitarian. I don’t see the point in it anymore. I don’t see the point in having a pretty dress and doing my hair and makeup. I don’t see the point of going to the art museum. I don’t see the point in finding the beauty in this world and documenting it in my photography.

As I sit in my bedroom, the wall opposite to me is covered in my hiking photographs as well as a map of the entire Pacific Crest Trail with planning notes on it, as well as marker covering the portion of the trail I’ve hiked to date. The pictures are beautiful. Close ups of my favorite plant, the Saguaro cactus. Orange rock arches from Utah. Muddy boots from the Rio Grande. Rushing waterfalls. Mountain ranges stretching past comprehension. I used to seek out this beauty. I used to ache for it.

My utilitarianistic ways are causing problems: I’ve lost my appreciation for the world around me. Lost the joy. I realized this last night when I found myself reacting to others’ reactions on Notre Dame burning. Notre Dame—burning. 800 years of history and beauty and worship. And I didn’t care. My first thought was, “but did anyone die?” Which is important. But I couldn’t understand the world’s feelings of loss. I couldn’t see the beauty that was lost. I couldn’t understand the beauty, so I ignored it. I’ve ignored beauty for the sake of beauty for so long, beauty didn’t register with me. The loss of beauty didn’t affect me.   

As I write this, I know I need to jolt myself out of this rut. Of all the stories throughout time, when did you meet a good guy who didn’t appreciate beauty? It’s always the bad guy. There’s a reason for that. Beauty should be appreciated for its own sake. Food should be good, not only good for you. Art should exist for art’s sake. Joy should exist, be cultivated, expressed, and experienced.  I want to blame this on living in the city. I don’t have my mountains, my waterfalls, my saguaros, but that’s not the point of life. It’s to find joy in all of God’s creation. It’s to appreciate all of this world, cultivate it, and hand it back to God in appreciation.

Today, I will find joy. I will appreciate it, respect it, love it, and I will hand it back to God with thanks.

Life Lessons from Nursing

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1. Doctors are humans too. Every member of the team can make a mistake, so be vocal when you’re confused or have a concern. You’ll either learn something new or catch a potential problem. Patient safety is my priority at all times. (Sorry, hospital administrators, but it’s not patient satisfaction. Safety will always trump satisfaction.) And the best way to prioritize that is by double checks, expert advice, and allowing everyone a voice. My resident the other night caught something I’d missed. The next night, I caught something he’d missed. It’s a team effort. Neither of those misses caused harm to the patient because the other team member caught them before they reached the patient. 

I had a patient years ago with a low hemoglobin. No one could figure out why and it got low enough that we had to transfuse at least two units of blood. The day after the transfusions, the lady who cleaned the rooms came to me with a trashcan from the patient’s room. She told me she thought I’d like to see what was in it. Piles and piles of bloody Kleenex. The patient had been throwing them in a trashcan on the side of the room I rarely walked to, and we’d all missed the now obvious problem of chronic nose bleeds that the patient hadn’t thought important enough to bother us about. All members of your team are important. 

2. Look at your patients.  Like actually look at them. Don’t just look at the labs or the monitor. Really look at them. Listen to what they’re saying, verbally, with body language, and their breathing. Half of your head to toe assessment is done between the door and the bed.

Don’t just listen to what someone says to you. HEAR what they’re saying to you. Be present and available when you interact with anyone. Be honest with the people around you, be real, be open, because you may need someone to truly hear what you’re saying some day too.

3. The day you stop studying is the day you should think about switching careers. This world is amazing. The scientific world alone is so detailed, so intricate, you can spend your entire life learning about it, and never come to an end. And that’s just science. Add literature, art, music, social sciences, and you’ll never be bored. Learn. Dig deep to understand something new. Study for that new certification. Someone prescribe a new medication? Read up on it before you administer it. Ask for explanations. Research the answers from a reputable source. Never stop asking questions. Never stop learning. 

4. Inpatient care is important. Give bedside care a shot. Learning how to care for someone completely reliant on you is eye opening. Their food, their movement, their water, their breathing, their basics of all functionality, rests on you. But if it’s not the right fit, move on. Take the experience, then find something that works for YOU. Nursing has this amazing plethora of options to experience, and they’re all wonderful. SANE and forensics nursing, insurance, education, clinic, research, public health, flight nursing, hospice, legal consultant, dialysis, case manager, academic writing…pick something. But give inpatient nursing a shot. Even if it’s not right for you, it’ll teach you important skills and perspectives that will help in your life and your career.

5. Know the drugs you’re dealing.  Know the generic and the brand names of the drugs you’re working with regularly. Peeps in America use them interchangeably and patients may know one name, but not the other. Always look up unfamiliar drugs before administering them. The one time you don’t, will be the time the patient or family has 10 questions and if you can’t answer them all–you’ve lost their faith, which is rarely retrievable. But more importantly, the one time you don’t look up the unfamiliar, is the time you miss some detail like, it worsens liver failure and your patient is already jaundiced. Refer to number 1. Every member of the team is important because patient safety relies on the Swiss cheese holes mismatching enough that nothing falls through.

6. Hire a CPA.  My life supposedly “slowed down” this past year. I still worked in 4 different states, and had two different state residencies, one state which I never actually worked in. My taxes are complicated. I study regularly to keep up my nursing skills. I can save someone’s life, but I cannot interpret tax forms and questions from the IRS if my own life depended on it. And that’s ok. Be OK with what you don’t know and ask for help. If that’s with your taxes, OK. If that’s with a healthy diet or how to exercise, or how to change a tire, that’s OK. We can’t know everything in life, but we should know how to find the answer, and that usually involves asking an expert in the area.

7. Get the hell outta Dodge every once in a while. As much as I advocate throwing yourself into your career through study, time, energy, and passion–take breaks, and take them regularly. Find a hobby, an outside passion, something to remove you from your day to day. Monotony will kill you emotionally and mentally, kill your passion for your career, and those two combined could physically kill a patient. I hike. My free time consists of hiking, preparing to hike, and writing. I spend time studying every day, but if I don’t mix it up, change my scenery regularly, and give my brain a break, I won’t be functioning well at work soon enough. In the ICU, the lights, the beeps, the constant monitoring, causes anxiety. It’s hard to come down from that most days. Won’t lie, a couple glasses of wine after work usually help, but so does being in the woods and climbing a mountain. Replacing heart monitors and ventilator alarms with running water and birds chirping recharges me. Find what recharges you and purposefully schedule regular time for that activity and only that activity. Put away your email, your phone, and embrace whatever it is you’ve chosen as your recharger. You’ll be a better nurse and a better person for it.

Angels Who Cuss

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“You’re the real hero!” That’s sweet.

But wrong. I’m tired of being called a hero. I’m not an angel in scrubs. I cuss. (A lot some days.) I have strong, and at times harsh judgements on other people, even my patients and their family members. I get things wrong. I forget your requests sometimes. Others times, even though I return shortly with a smile on my face, I simply didn’t want to do it and I internally grumbled the entire way. Sometimes, I make up answers to your questions because I’d rather get the info wrong than you lose faith in my care.

Maybe that story of the hairdresser and her picture of the nurse’s sneakers post shift got me thinking about this. I see those articles fairly regularly. I’ve always shrugged my shoulders at them because I never related to them. What is it about my job that makes me superhuman or heroic? Training the average layperson lacks? Willingness to get gross by changing a wound dressing or by doing high intensity tasks such as CPR? Eduction and personality.

I’m doing my job. That’s it. Sometimes I’m better at my job than other times. Sometimes I want to be at my job. Sometimes I don’t. I am getting paid to do what I do. And I enjoy it. I don’t do it out of empathy or compassion, I enjoy it. I understand those aren’t mutually exclusive. The majority of nurses, and other healthcare providers, use empathy and compassion with every patient. But that doesn’t make us saints. It makes us human. Or shouldn’t that be a human trait?

Teachers, construction workers, CEOs, graphic designers, bartenders, Uber drivers, cops, gas station attendants, journalists, computer programers, bankers, chefs, we’re all human. We all have empathy and compassion. We all have gut instincts. We all have mercy. Let’s bring it out a bit more. I’m a nurse, but I’m not in the only career field that needs mercy and compassion. And no one’s career choice should limit or define their humanity. Don’t be the basic bad guy from an 80s film. Be better than basic. Be merciful. Be kind. Be a human.


Also, stop calling nurses angels. We like to drink and we like to cuss. Among many vices.

Plant Friendships

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Friendship is weird. Out of billions of people on this planet, I choose you to spend time with. I choose you to call for coffee, music, grocery shopping, Netflix. How do we choose each other? Biological family isn’t chosen. I’m kinda stuck with you. But friendships are truly a freewill experience of love and companionship. As a Christian, I believe our family is given to us to understand how to love when we don’t necessarily want to. My parents, my priest, are all in my life to learn obedience to someone outside of myself. That’s important. (In a healthy relationship, it’s important. In an unhealthy relationship, it’s detrimental and horrible and should be pushed away as soon as one is able. That’s not what this post is about however, but I do recognize that it’s a possibility and sadly, a common possibility at that.) It’s important because if I can obey my parents, my priest, it’s a step in the direction of obeying God. That’s part of being a Christian. I’m not very successful in that part to be honest with you. 

But friendship? Why do you exist? Either of us can walk away at any point. Sometimes people do walk away, for good or bad. Sometimes they stick. But why do we stick through it? Friendships can be painful for so many reasons and yet, here we are, pushing our way through life together again. Sometimes it’s easier without you, dear friendship. Sometimes I don’t want to work through our problems. Sometimes I don’t want to be honest with you. Sometimes being fake and closing myself off is easier. Sometimes letting you keep your walls intact is easier than breaking them down. 

I’m really bad at keeping plants alive. Human beings, cats, I got you. Human beings’s hearts change rhythm on my ICU monitor when something is wrong. Cats meow when they’re hungry. Plants just sit there. I’ve killed a cactus plant before. Do you know how difficult it is to kill a cactus? I’m really great at killing plants. The green thumb blessed almost every other person in my family, not me. I stick to fake plants. I like them. Gives me greenery. Doesn’t wilt or attract bugs. But they don’t take in CO2 and give back O2. Fake plants don’t purify my air; they simply take up space. Do I want a friendship that simply takes up space or do I want a friendship that purifies both of our air supplies? If I choose the real friendship, I have to start putting effort into it. Feeding the soil, watering, but not over watering, giving the right amount of sunlight. In a way, plants are easier than people. I can look up online the exact amount of water, sunlight, type of food, any given plant needs. What does my friendship need? What does my friend need? What do I need? How do we come together with both of those needs? Answers appreciated.

Stairway into the Light

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I love honey. It’s one of my go to snacks on the trail for a quick hit of energy. And in my tea, I’m heavy handed in both my honey and lemon administration. No regrets. 

But I love the flavor. I love bright vibrant flavors, colors, boldness. Wrap me in sunshine, lavender, and bright amber hews and I’m on cloud nine.

My life is bland at the moment, flavorless and monotone. Stagnation in a pit I’ve dug myself. Like the lemmings, I should build a stairway up and out, but to where? Where will I be when I crawl out into the light once more? Does it matter? As long as there is light and sun and warmth on my skin once more?

And then there’s the matter of that set of stairs. Can someone throw down the wood, the nails? I might be able to get out without a hammer, but if one was thrown down, I wouldn’t throw it back out of this pit of stagnation.

For once I have the energy to build myself out, but I’m missing the tools and materials. I need help. I need the mountains’ help. I need my prayer rope’s help. I need Sarah Vaughn’s help. I need the help of a simplistic week in the woods. I need my nephew’s giggle and my niece’s smile.

I need you. Help me build myself out of this pit into the light. 

2/18/2019

Tug of War for a Code Cart

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I love circulating and scrubbing liver transplants. Kidneys/pancs at great too, but the livers are fascinating. The organ does so much for our bodies and when it fails or is damaged, the multi system consequences are disastrously….fascinating? Yeah, that’s the word. I’ve learned my sickenly morbid enthrallment with pathophys is almost an industry standard. At least, most other RNs and MDs don’t give the sketchy side-eye when I mention how much I love things like HIV and liver failure.

I’m on call over night for the transplant team with my favorite scrub tech, and really my favorite team from anesthetist to residents to surgeons. Notified at 9pm, set up at 3am, roll back at 5am. Of course we’re delayed. Most are, due to either the donor liver transport if it’s out of house, or the recipient arrival, cooperation, or labs.

The week prior, this same team had run the smoothest code I’ve ever seen in any situation. It was beautiful, a work of healthcare art. And we were proud of it. The experience had brought the whole tam together in a way unparalleled throughout the unit. The transplant room is also one of the trauma rooms, so it houses a code cart 24/7. We check all code carts every 24 hours, regardless of use. Prior to a transplant, I double check the daily check. Another way the OR allowed me to release all OCD tendencies I might have ever had.

At 6am, my patient rolls back. This guy has active LBBB (left bundle branch block, which means his electrical part of the heart is slow in critical places) and lives in afib (a wonky rhythm that drastically increases your risk of clots and hence heart attacks, strokes, and pulmonary embolisms). Regardless of the patient’s heart history, the most dangerous part of most surgeries is intubation and extubation. With livers, repurfusion beats them out, but only barely. Anesthesia resident, propofol given, blade in hand to intubate, is disrupted as the OR door flies open. One of the night nurses, an overweight woman who will pay cash to other nurses to take her surgeries so she can continue sitting in the lounge, walks in and begins to unplug the code cart. She says nothing, makes no eye contact.

“Tom,” I said, holding my hand up to pause the confused resident. “Hold on and bag him for a minute.” He breaths for my completely sedated and now paralyzed patient. I ask The nurse what she needs from the cart and inform her of the obvious, our impending intubation. She ignores me and begins to wheel the code cart out of the room.

I run across the room, intercepting her and stand between the cart and the door.

“The manager wanted the cart brought into the core.” I point out the three other carts we keep in the OR and relay my patient’s heart history. She seems unphased and repeats the managers request, pushing the cart past me. At this point, the phrase, “pry it from my cold, dead hands” might have exited my mouth, but it all became a haze. I ended up physically removing her hands from the cart, plugging it back in to the wall, adding an emphatic, “it stays. If the manager has a problem with that, she can come speak to me herself.”

She left. We intubated.

Shortly after, while anesthesia placed the large IV lines in the neck and the arterial lines in the wrist, I was inserting the catheter. Doing so left handed, I left my back to the door. So when I hear the door open, I make eyes toward my scrub and he interprets it correctly to keep an eye on the code cart. My manager walks up behind me.

Our manager always wears hospital scrubs, but I’ve never seen her scrub or circulate a case. Rumor has it she did open hearts about 15 years ago. Since then, she has suffered from the middle-management curse of forgetting all the knowledge one learned at the bedside, but being forced by upper management to act as if they hadn’t.

“Are you ok?” she asks. I pick up my patient’s penis in my right hand, holding it upright and refusing to make eye contact. The last thing this patient needs is a UTI from breaking sterile technique.

“I’m good. My patient’s pretty sick, but I’m good.” Still no eye contact as I twist the catheter until it pushes into the urethra.

“I heard there was a misunderstanding over a code cart.” I hit the prostate. More twisting of the catheter.

“No misunderstanding. She tried to take the cart, I explained the severity of my patient’s condition, and I kept my cart.” Up to the hub, no urine out. I take my non-sterile hand and push on the bladder.

“Oh. I knew the team had used this code cart last week.” Healthcare art. Word had gotten around. “And I wanted to make sure it was ready for the next transplant.” Seven days of scheduled surgeries and now she’s worried about it. What about the hip replacements all day yesterday? Those can bleed almost as much as a gunshot wound to the spleen.

“In all respect,” more bladder pushing, “we check those code carts every day.” Finally! Urine! It’s gross, thick and red-tinged, but urine. I hate to think what this guy’s creatinine is. “It’s been checked seven times since the last code, plus an 8th time by me this morning before the patient rolled back.” I secure the catheter to the leg, bend down to hang the bag on the table, and stand back up to finally make eye contact. “And we don’t have to move a code cart to check them.”

She looks at me. She looks at the catheter. The room is silent; everyone’s eyes down to whatever they’re working on. Her face morphs from chastisement to fake bubbliness. I get more nauseous from that than the smell of the new liver being prepped. “Ok! Looks like you’ve got everything under control here!” Yes, now leave us alone, I say, internally impersonating Grumpy Cat.

As the door closes behind her, a slow whistle comes from the surgeon’s prepping the liver. “Oh shut up, Schmitty.”

No code that day.

Two Minute Increments

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I lost a patient today.

I didn’t even know his name, which seems like the first thing you should have when you’re trying to find someone.

In the hospital, we use trauma names. Tango, Tango. Last name comma first name. Which sounds like a fun night out in red heels that hurt my feet. Or Bravo, Bravo. Last name comma first name. Which sounds like we’re applauding something. But we’re not. You just didn’t have ID on your body when the cops or EMS found you.

I lost a patient today and I didn’t even know his name. He spoke to me in slurs when the ER nurse wheeled him up on the stretcher to my ICU. But it was all just slurs. His belly was distended, but not like the adorable beer gut on your favorite middle-aged uncle, more like when an alien’s about to bust out. His skin was orange and I didn’t need his lab results to tell me he was in full-blown liver failure. This was Mr. No ID Foxtrot, Foxtrot. He smiled at me when I made a joke. He started vomiting blood shortly after that.

There are two groups of people in this world, nurses and parents, who know the difference between vomit and projectile vomit. The first gets on your shirt, the second—hits the wall. This was the second kind. He passed out while I called for help and suctioned all the blood out of his mouth. Passed out is the nice way of saying he lost a pulse. Which is a nice way of saying his heart stopped. Which is a nice way of saying he died.

But have no fear, Mr. No ID Echo, Echo! I’m really great at breaking ribs. I’ll pump your heart for you! You laughed at my joke; it’s the least I could do.

Two minutes. Two minutes of CPR is worse than anything a former East German Olympic coach could throw at you in a HIIT cardio class.

I can’t remember the joke he laughed at. I remember his smile though. That’s how I keep doing the chest compressions even when the blood starts spurting on to my face and scrubs. Every compression. More blood. I remember his smile.

Epi. Intubate.

Epi. A bag a fluid and bicarb.

More epi. Bicarb.

Bicarb again.

We’re out of bicarb. Someone grabs another code car from another ICU. The room is trashed. A flood of people both in the room and outside the door. I want to scream at them. YOU DIDN’T SEE HIS LAUGH. YOU DON’T KNOW HIS NAME EITHER.

But two hours of two-minute increments later, the doctor tells us to stop. I yell, “FUCK” at the top of my lungs, throwing an unused syringe to the ground.

I didn’t know his name. He laughed at my joke and I didn’t even know his name.

_____________________________________________

*The author is not writing about one particular patient. This is a representation of multiple combined experiences throughout her career as an OR, ICU, an ER nurse.

The Monster has Neat Handwriting

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The monster has a pouch on its stomach, like a kangaroo. Today it pulled a pencil out of the pouch and pointed the eraser at me. It began rubbing the rubber eraser against my neck, behind my ear. The eraser bits, collecting on my shoulder, sapped my energy from me. And with every eraser bit, the monster grew.

Rub. Rub. Rub.

I slowly begin to drain.

I had plans for today, you know! I have friends I want to call. I have groceries to buy, books to read, mountains to hike, beers to taste.

The eraser moves from my neck to my back, down each of my legs.

Rub. Rub. Rub.

I can still move my arms, so I text my friends, canceling that hike, those beers. I cruise down my Facebook feed, watching my friends activities from a far, as the monster rubs the eraser across my shoulder blades.

Rub. Rub. Rub.

Down my arms until it reaches my hands and I collapse on the couch, the monster taking up my now-too-small living room once again. Pokey bits pricking me with each of my breaths. But they’re shallow now, not from fear of being poked, but from the utter loss of all energy, motivation, or anything good. I can barely lift my head off the pillow to see the eraser bit piles of my energy strewed over the floor.

I can’t move. Too much has been erased. But that conscious paralysis sends my brain in to a screaming match between my brain which is trapped in my skull, and my heart trapped in my chest. Both are pounding.

The only thing that stops the pounding is the realization that the monster is writing. His handwriting is neat, annoyingly so, and he writes on a paper the size of my wall, the now worn-down eraser bobbing in the air as he makes his annoyingly neat letters. He is writing a list of my failures. A list of people who don’t love me. A list of pipe dreams.

The monster tapes the paper on the wall facing my now paralyzed head.

Fall, 2017

Work

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During tonight’s shift I was kicked in the chest twice by a coherent and oriented patient. There’s nothing insightful or deep about this. I physically hurt and simply wanted to verbalize it to someone, even if it was the void.

A Queen’s Coronation

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My trail name is Tribal Queen. There’s a story behind that, which, has practically become family lore, and, if I didn’t have the picture to prove it, most would find unbelievable. But here I am, eight years later, with a nickname, a memory, and a picture. But names are important. Sometimes our names become who we are. Sometimes we become our names. I am becoming my trail name. I am slowly processing and connecting to being a Tribal Queen.
Trail names are organic in that they usually originate from an entertaining story, habit, or personality trait. The only hard and fast rule is that no hiker may name themselves; another hiker must knight you with your new name. (My dear friend Kyaera gifted me Tribal Queen while we hiked in Custer State Park.)
I’ve learned to embrace this knighted trail name, even accepting my nativity during the actual event. But what I’ve learned from this name is not the care you must take in gifting baseball hats in certain cultures, but rather the importance of tribes in life and how to embrace my tribes, cultivating and helping them grow. Those are the people in our lives which surpass the acquaintance level, the casual friend even. It’s bigger than family. A tribe is a group of people who choose to be together. They live their lives together, work through problems and pain together, rejoice together, experience life—together.
There is a permeating idea in modern thought of otherness. Separation. Judgement. Projection. It’s the opposite of a tribe; it’s the separation of tribes. It’s the disassociation from other humans. Severance of ties that once connected us. But does this idea of a tribe feed into this otherness? Does finding our similarities yoke us to pointing out our differences? I’d like to claim certain of my tribes (I count probably four in my current life) are better at this than others. But, logically, I know we’re not. There’s always judgement of some kind, a statement that we or our choices are better than other choices. When I truly believe ‘Love God’ and ‘Love your neighbor’ should be the tenants I live by in life, how do I combat this otherness in choosing my tribes? My neighbors, according to the parable of the Good Samaritan, are the people outside my tribes. I’m asked to choose love, not the easy honeymoon stage of love, but love despite despising what someone stands for and the choices they make. I have to choose to still say verbally and actionably, “I love you.”

The only way I comprehend doing this, is by seeing another person. To remove them from these preconceived or loudly stated, chosen or given, groups, and see them.

“The thing is, when you meet people, all generalizations fly out the window.” Maira Kalman