Category: Uncategorized

Angels Who Cuss

On By Tribal QueenIn Uncategorized

“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

On By Tribal QueenIn Uncategorized

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

On By Tribal QueenIn Uncategorized2 Comments

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

On By Tribal QueenIn Uncategorized

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

On By Tribal QueenIn Uncategorized1 Comment

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

On By Tribal QueenIn Uncategorized1 Comment

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

On By Tribal QueenIn Uncategorized

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

The Green Pokey Monster, an introduction

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There is a monster who only comes to me when I’m alone. It creeps up behind me and sits on my shoulder to ask a simple question.

“What’s he doing?”

This monster prods me, he pokes me in the shoulder, kicks my ear.

“I bet he’s having fun. His life is probably so much better now—without you.”

The monster is green. A dark forest green with rugged, tough skin, which has pokey bits that prick you when you try to pick it up to rid yourself of it. It starts out tiny, about the size of a mouse, but it grows.

It grows with every question I answer, every question I add to the pile myself, always promising to make this one its last question, last prod. It grows and grows until it takes up my entire living room, and while before, it was spacious, with enough room to do my yoga, I can now no longer breath. The space this monster takes up is suffocating me.

And it simply sits there. It sits there and breaths.

And pricks with its pokey bits. But now, I can’t pick it up. I can only sit, breathing. But only shallow enough so I don’t hit a pokey bit.

Sometimes tears shrink the the monster. Sometimes I have to push my way past the pokey bits, bleeding, to maneuver my way out of the now too-small living room and do something. Anything. Groceries at 3AM. Landry. Impromptu sunset hike. NPR podcast. Call someone, pretending I’m not still being poked. I’ve even seen my cat defeat the monster by rolling on her back requesting a belly rub.

And sometimes the monster shrinks. And sometimes it stays in my living room.

Fall 2017

Cutting Pack Weight and Healing

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Ultralight hiking is a new way to think about my backcountry life. “I didn’t use this once on my last trip.” “Why is this here and not two inches lower?” “Will this make my life better?” Last night, I took scissors to my beloved backpack. I removed ties, zips, cords, pockets, lids, and so many unused things weighing my pack, and me, closer to the ground. I’m making it fit my life, my needs and it physically hurt to make the first significant cut, the no-going-back-now cut.

If it’s so hard to do that with a blob of nylon and cord, it makes a little more sense as to why I have such a hard time doing the with toxic, harmful people and activities in my life. They weigh me down more than the big bulky extra pocket on the font of my pack.

Snip snip snip.

It’s comparatively easy to scissor away the pocket, while the hate in my life remains.

Hatred and pride stick to my self. I try and peel it away, but there’s always another layer underneath. And like Eustace, needing Aslan to tear away his knobbly dragon skin, I too need help in peeling away my hate.

Love doesn’t peel away the hate; it dissolves it. Love cleanses the rust and beneath appears that beautiful original image. I move freely again, my joints no longer inflamed and stiff from rust and decay. My own hate is not, however, an outside force like bacteria or a virus, breaking my body down. I wish I could blame it on something outside of me, outside of my control. But usually, my affliction is an autoimmune inflammation of hate. I do this to myself. I rust my soul to the bare bones. I allow rigidity to set in by not stretching myself with compassion or exercising practices of kindness.

This hatred, only formed by my own lack of love, is my soul attacking itself, attempting to defend from pain. Hatred is pain, and only causes pain. My soul’s immune system attacking itself, causing more inflammation, rust, and decay.

Thankfully, modern medicine is developing ways to treat autoimmune disease, so there is hope. There is and always was hope. Christ is that hope, that healer. He is the constant, but the healing depends on me. Am I going to regular checkups? Sometimes God is my primary care doctor, prescribing blood pressure meds, exercise, or dietary changes. More prayer, more listening, less gossip. Sometimes unexpected trauma happens like a friend’s suicide, or piercing doubt in my faith. My foundational spiritual health, what my primary care has been prescribing, saves me. And sometimes I don’t care for my soul for longer than I’d like to admit. Sometimes the infection runs deep and God becomes my ER doctor, trying to save me from sepsis.

Whether He is prescribing daily BP meds, or cracking my ribs as He restarts my heart with CPR, God is, and always has been, my healer.
1/10/19