The Thing About Clinical.

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Here’s the thing about clinicals, and it is may be the most important thing, I love it.

Also, conveniently, importantly, I happen to be good at it. Thank God.

After doing two years of online class, squeezing in study sessions whenever I could as I chased around a toddler, I am out of the house and going to clinicals twenty hours a week, working with a family practice physician at a family practice clinic in Dallas. I will do 180 hours over about 11 weeks this fall and again in the spring before finishing up with 360 hours before graduation sometime towards the end of next year. And while the concept of graduation has always felt like a mirage, a distant and unrealistic possibility, I’m starting to be able to taste it now and feel like maybe it will eventually happen.

So the first and most important thing is that I absolutely love being a primary care provider, a notion that I was honestly wary about the closer and closer I got to clinical. But I only have ICU experience! What if I go and hate it and all this school was a waste? What if I think it’s boring compared to the ICU high-stakes? What if I end up completely not caring about someone’s sore throat and wishing that they would code in the office instead? Yes, these are real questions that I have had and I’m trying to be honest about my hesitations, as silly as I see them to be now. Because even though I knew I could no longer emotionally and physically handle life at the hospital, at least for a while, I had real and tangible doubts about switching to such a drastically different work environment.

So, what do I think now? Would I jump into action if someone coded at our office, letting my ICU adrenaline rush back as I pulled out all those life-saving skills that I have grown so fond of? Yes. Of course. I would love that. But there is something SO NICE about knowing that you can stop and go to the bathroom before seeing your next patient and that you don’t have to go completely nuts if you get behind in your morning. No one is going to die if you don’t get in there and look in their ears RIGHT NOW. No one is going to crumble with a hemoglobin A1C of 8 while they’re sitting on that examination table. No one’s life is hanging upon how quickly you can put in those orders for thyroid labs. It’s freeing and it’s still taking me some time to get used to. And even more importantly, I feel like I’m making a huge impact doing primary care, keeping those people from ending up in the ICU to begin with.

I’ve had to be careful not to live out of my ICU experience, which has been harder than I would’ve thought. It’s frustrating to be so good at your job and then suddenly back at square one, wearing a student badge, not knowing what to do with that growth on my patient’s arm. Is it a mole? Is it cancer? Can I just pretend I didn’t see it? It doesn’t matter anymore that I can put together a ventriculostomy and help a neurosurgeon insert it. It doesn’t matter anymore that I can use a rapid infuser and get several pints of blood into a patient in only a few minutes. It honestly doesn’t really matter that I can code a patient because my physician has never had that happen in his office after twenty-five years of practice.

So are all those skills a waste, all that fine tuning of my nursing expertise? Should I just shut up about all the things I’ve seen and done (and some of them are QUITE ridiculous btw) or can I use all of that prior experience somehow? Well, I think it’s a little bit of both. While I have had to stop telling stories of my glory days as if that makes me more legit, I have gleaned something from seven years in the ICU and that brings me to my second point: I’m actually, surprisingly, doing pretty well as a PCP.

My physician came to me last week and told me what a good job I was doing, that he was really surprised that this was my first clinical and that I was a natural at this. You cannot even imagine how much those words meant to me. After two years of getting no feedback other than grades on tests, I finally got some real-life affirmation that I made the right decision in going back to school and that I will end up in a job that I will excel at. He went on to describe the difference between the medical residents (who have had no real patient interaction before) and me in one slightly amorphous but significant variation.

He said I’ve got really good “clinical judgment,” which basically means that I can tell a mountain from a molehill or “see through the BS,” as he also put it. When the woman comes in talking about her ankle pain, giving me details as I ask questions and dig a bit deeper, I can somehow tell that she wants to talk about getting on medication for depression instead of treating her ankle. When the schizophrenic teenager comes into the office complaining of abdominal pain, I can somehow figure out that she just wants to talk and there is absolutely nothing wrong with her belly. When the older lady comes in wanting an MRI for knee pain, I can see that it’s osteoarthritis rather than an injury and a MRI would be a waste of time for her. Some of it is reading people, some of it is physical assessment skills, and some of it is just remembering all the stuff I’ve learned over the past two years.

While this ability to distinguish between what the patient is saying and what they really want seems innate to me, apparently not all providers have this. From what I’ve heard, many physicians have to learn this over a long period of time, while I seemed to have picked up this intuition from years at the bedside. I’m not saying I’m better than any of the residents I work with; we just have different acumen at this point acquired from our different backgrounds. And if you think about it, it makes sense- people are just people and you get good at dissecting them, reading between the lines, getting to their true needs the more time that you spend with them. So it seems that all my ICU experience has not been a waste and although I’m not using the same medications or doing the same procedures, I have become pretty good at reading people and that’s more important than I could’ve realized.

And despite my initial preconceived notions, primary care is anything but dull. We had a man walk in off the street who hadn’t seen a doctor in twenty years with feet that were practically necrotic from years of uncontrolled diabetes. I saw an entire family in the same exam room, each with bipolar, who all wanted Adderall and antipsychotics, and I barely got out of the room in under two hours. I had an older woman tell me very seriously, to my face, that “sugar is the new smoking” as she divulged her health plans to me. I’ve had people ask me about getting their animals registered an emotional support animals, which I had no idea was even a real thing. I had to bite my lip as a young male patient explained the intricacies of martial arts to me, with an in-office demonstration.

I have met so many interesting people, some of them nice, some of them grumpy, some of them fastidious about their health care, some who haven’t ever been to see a health care provider, all in only a few weeks. People are just people! Same as they are in the ICU or at a clinic or walking down the street. And people never fail to provide entertainment.

Finally on a personal level, starting clinical couldn’t have come at a better time for me. After our recent pregnancy loss, I needed to get out of the house, to feel valuable, to feel affirmed, and to feel like I still had a future full of hope. And thankfully, I have felt all of those things. Evy seems to be doing fine with the transition and I enjoy only having to split my week, not devote all of it, to work. Seth and I are working as a team to make sure that groceries get bought and dinners get made, and after all the hard things that have happened for us over the past year, God allowed this one thing to go so very right. And I’m so very thankful.

I’m sure I’ll have more stories to add as the weeks go by but I wanted to give you a glimpse of this wonderful new world that I’ve entered into. Thank you to everyone who has prayed for us over the past weeks or months or years. Life is painstakingly hard sometimes, but it is worth it and we have no option but to move forward.ย So forward I go, into this new world of prescribing metformin and writing for thyroid labs and learning way too much about SSRIs.

It is going to be worth it. It already is worth it!

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He Follows Us Into the Dark

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I had a really hard time deciding whether to actually publish this post or not. I wondered if it was too depressing, too intimate, too real and raw. I didn’t want to sequester all this emotion for the goal of obtaining pity because this has happened to more women that I personally know than I can count. Sadly, it seems like it’s the norm instead of the outlier. And even though I did end up publishing it, this post is still probably all of those things, including very personal. But I committed from the very beginning, that I would blog about real things, not shadows, so here we are. I hope you can appreciate that and understand that this post is about dealing with heartbreak, not pining for sympathy.

Miscarriage is probably the last thing that people want to talk about. It’s uncomfortable, it’s heartbreaking, it hits too close to home for many. It’s all too common and altogether too sad. I don’t care how comforting it is to think of little angel babies up in heaven, it’s still a loss for those of us left here, in the now. And I never understood, before my own pregnancy loss, why people hated the term miscarriage. I had never given it much thought but now I get it. The word is too close to other words that do not fit- mishap, misunderstanding, miscommunication. Mistake.

My baby, if only the size of a pea when he went home, was not a mistake.

I have no room for the word miscarriage in my heart either.

For the first few days afterwards I spent a lot of time in bed. I literally got dehydrated from crying and couldn’t get on Facebook and bear to scan through pictures of people with cute baby bumps. I didn’t answer text messages. I kept the blinds drawn. I ate full gluten brownies. After putting our daughter to bed at night, my husband and I would pick up dirty Mexican food, drink vodka sodas, and cry. Then we would watch Parenthood until we cried some more. We both needed to grieve and we comforted each other with our tears. The worst part was when we had to explain to our two year-old daughter that mommy and daddy were sad because we had a baby who went to be in heaven with Jesus. It about broke my heart all over again.

Those first few days were easier in some respects because I embraced my grief. I realized I was allowed to mourn my loss. “But I wasn’t even that far along,” I said to my friends who had also lost babies during pregnancy. “I feel like I shouldn’t be this sad.” But each one said yes, I should. I needed to feel that pain and sit in the sadness that had enveloped me. And so I wept bitter tears and asked God, “why?” and tried not to think about what could’ve been.

But that could only last so long, until real life came calling to me from outside my bedroom just a few days later. I had to study for a final exam in one of my grad school classes and take care of my daughter and go to the grocery store, all of the other basic life tasks that I usually didn’t even think about. But shouldn’t everything stop with me? Shouldn’t the whole world wear black for me? Shouldn’t the sky rain down thunder and lighting, weep big watery tears, cover all of us in darkness?

If only the world would stop, but it didn’t. And maybe that is for the best.

I knew myself and that I would gravitate towards an extreme- to either stay busy until I was completely numb or give into the darkness that had visited me before at certain periods of my life, most notably when I got diagnosed with my autoimmune disease. So thenย I had to make a choice- would I let the darkness consume me now? or would I choose to resume my normal life? In the end, it was a little of both.

Sometimes I did let myself sink. I succumbed to the waves of grief that rolled over my head and didn’t make any effort to swim. I let myself be pulled into the blackness of the sea, not even trying to hold my breath. I was tempted to quit everything, stop NP school, and find a new path for my life. I exhaled all the air I had left. I wanted to feel nothing, even for a moment, and yet, as I floated limp in that ocean of darkness, I found that I wasn’t alone. God met me in that place, giving me rescue breaths, letting me stay underneath the surface, letting me feel that pain, but not letting me drown, as much as I felt like I wanted to.

His voice told me to get out of bed those first few days, as much as I cried “no” and refused. He whispered to me that this baby was safe with him and would never have to know the kinds of pain that I did, and that thought actually gave me so much comfort. I realized that this baby was never meant for this world and that it didn’t help me to think about him toddling around the house and playing with my daughter (I feel like God told me it was a boy, which was very helpful in my grieving process). It didn’t do me any good because that was never meant to be. He was always meant to be with the Lord and I decided it was best to let my imagination leave him there. God reminded me of redemption, that there was hope for another baby, that all was not lost.

I don’t know how women get through pregnancy loss if it’s their first child. As sad as I was at losing what I had hoped would be the next member of our family, I already had a daughter. I knew that regardless of what came in our future, I would be dropping off a little girl at kindergarten, going to soccer games, and watching her walk across many stages. I wasn’t waiting to become a mom; I was already a mom. And my daughter was the greatest comfort during that time, giving me snuggles, forcing me to play and laugh, yanking me back into the life that I still occupied. Those women who have a loss as their first pregnancy have a different story, and a different kind of strength.

Then time passed and the days started to get more manageable, although I still lie in bed at night and shed a few tears sometimes. I have hope for the future. I hope we get pregnant again and that the Lord has another tiny human waiting to join our family. I have no reason to think that that won’t be possible. And yet, I think the Lord is using this pain to teach me another lesson besides how to grieve, something that I hadn’t anticipated, including the fact that the enemy will do whatever it takes to strip us away from the Lord. God didn’t cause us to lose this baby but he allowed it, and maybe he allowed it so that I could know greater freedom, namely freedom from fear.

I walk around with a fair amount of fear strapped to my back, sometimes letting those fears weigh me down more than they should, cripple me even. Many women I know struggle with and have accepted fear as a part of their lives, including me. It’s not right that we’ve let it be integrated and woven into our stories. It is a thread of poison and we must get rid of it. And here’s the thing about fear, at least my fears- they are almost all theoretical. I fear what has never happened, what will probably never happen. So what happens when the worst possible scenario comes true? What happens when I’ve feared losing a baby and then one morning that baby is gone?

I realized that God is still there, right at my side, comforting me from within my heart, even after those fears have subsided. And He is stronger than every single one of them.

My God is not weak. Jesus commands the wind and the waves. He spoke everything into being at the very beginning of time. He gives life and he allows it to be returned to him. And He cares for us, enough to sacrifice his own body on the cross, to endure pain, to give us a new name and new identity, to bestow us with a piece of himself as a promise of what is to come. And He does all of this for our good, as much as we don’t understand how losing a baby or a spouse or anything else could be good. He is with me. He follows me into the waves. He gives me the freedom to sink underneath the dark water. But He does not leave me there to perish. He breathes life. He gives me a sword. He makes me brave.

He wants something more for me than fear. He wants freedom.

How will I gain that freedom? Honestly I don’t know yet. But I’m ready, for the first time in my life, to let go, to see what lies beyond those fears. I think the Lord has been waiting for me to say yes and trust Him more than I trust those fears, finally denying the idea that they would protect me more than my God. He has so much more for me than a lifetime of worry and anxiety. He died so that I could have a new life and a new name, so that I can walk with strength in this life as I yearn for the next. And I feel like I’m just beginning to understand what that means.

There are many things that I have had to let go of- planning another nursery, the idea of our kids being less than 3 years apart, a due date. But I really believe, as much as the pain still stings, that He is giving me something in return, an alternate gift that will help me walk in my calling as a woman, as a wife, and as a mother to any subsequent baby. I wanted another baby and I still believe that is a gift that He will give us, but for now he set before me the option of being free and I am attempting to walk down that path, even though I can’t see through the fog that still surrounds me at times.

He is setting me free for a joyful, messy, beautiful future, one hopefully accompanied by another, tiny, miraculous baby.

Not Just Math and Science

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I recently remembered something that I had pretty much forgotten: being a nurse requires creativity. Being a nurse means you are a creative person.

Let me back up. My husband and I have been talking a lot about creativity lately- what it is, what it means, what it looks like- because our definitions have grown very skewed, a veil over our eyes that has kept us from being able to identify it in ourselves. It’s not that we aren’t creative or full of ideas; we just have been labeling it as that. And that truly is a loss, as we have discovered.

For most of my life, I have equated creativity with artistic proclivity such as the ability to draw or paint or sing, usually materializing in the form of someone with brilliant tattoos who carries around an expensive camera at their side. Someone carefree and whimsical, someone with visions of grandeur and a disregard for menial things like budgets or timelines. And that is definitely not me. Before I started really delving into writing, which is very clearly a creative endeavor, and before my husband started calling out these qualities in me, I saw myself as linear, rationale, organized. I even had a nickname of being the “rationale” one, which I never really contested, although I always felt a bit hurt by the label. I didn’t want to be uncreative (aka boring) and I didn’t want to always be the reliable one. But in the midst of a strict nursing schedule, work out schedule, and stringent eating requirements, I figured everyone else was right. I wasn’t creative.

To make a long story short, my husband Seth has helped me over the years to realize that I am not only very creative but that even during that time- when I was working full time and seemed to be very organized- that I was operating in creativity because I was a nurse. And nursing requires a very unique type of creativity that many nurses don’t realize. And I’m writing this blog post because I wonder how many nurses feel the same way? That you are the sum of rules and time tapes, medication deadlines and charting restrictions, rather than dynamic problem-solver who manages one of the hardest jobs day in and day out. Admittedly, it is less fluid than being a freelance photographer but it’s no less artistic. I’ll show you what I’m getting at.

Say you have two ICU patients, one is sick and you’re titrating Levo and Vaso and running fluid boluses. You’re managing a vent, a feeding tube, an A line, a central line and you’re busting it to make sure the bags don’t run dry, the pressure doesn’t fall too low, the patient gets turned. Now in your other bed, you’ve got a walkie talkie who needs ice chips and to take a walk and some help in using the urinal (omg seriously, can you not do it yourself??) But you’ve found yourself in a tricky situation where you’re needed in both places and yet you can’t be there. You’ve got to find a way to elicit help from others, delegate, and prioritize in order to keep everyone safe. In that moment, you’re not worried about getting your charting done on time; you’ve realized that there are bigger things going on and that you’ve got to find a way to make it all work. And you do. If you’re a bedside nurse, you’ve got loads of creativity leaking out of you as you problem-solve every hour of the day, as you communicate with difficult family members or staff, as you form a picture in your mind that is so much more than tasks. As you impact people, who are so not linear.

When I was functioning as the family care nurse in the ICU, helping to coordinate donor patients, family meetings, and a whole host of other miscellaneous jobs, I had an encounter where I found myself completely in over my head. A grandmother was dying and the family was bent on blaming someone, so naturally, that became anyone in sight. The physicians, the hospital, even me. They were grieving an inevitable, natural death but they didn’t know how to process it and so the situation became riotous. With the entire family running back and forth from the hallway to the room, yelling and cursing, shouting into the air, it was my job to do something. They were scaring the other patients and it was quickly approaching a level where I would need to call the police to intervene. This kind of behavior wasn’t good for anyone and it couldn’t go on.

Then I did something that was risky and possibly even uncouth, based only on a gut feeling, a thick skin, and the kind of courage that only a nurse can have. But I did it because I was responsible for finding a solution to this problem and I would go down trying. At 26 years old, barely strong enough to pull a woman twice my size, I dragged the mother, the leader of this family riot, into the hallway and out of the ICU. Once out the door, I whipped her around to face me while she kept yelling, not even saying comprehensible words, and with my blue eyes blazing, I told her to shut her mouth, probably in about as many words. I will never forget the look on her face as her jaw dropped to the floor, stunned into silence. She immediately stopped talking, probably out of complete shock that this tiny white girl would command such a presence before her, and started to listen to me. We stood in the hallway and I explained, clarified, comforted, snapped her back to the reality of the situation and twenty minutes later she was hugging me and thanking me for bringing her back down to earth. Was that rational? Definitely not. Was it even the most logical solution to the problem? Probably not. But thank God it worked because I had to get creative to stop the mayhem and restore order. I had to find a way to make this better.

As I prepare to start NP clinicals, I find myself training for similar scenarios, ones that require a depth of understanding and communication that goes far beyond training in a classroom. Skills that only come from experience and freeform thinking, skills that are born out of creativity. How do I get someone who has been smoking for thirty years to consider quitting? Do you think telling them that smoking is bad for them and that they should quit is going to work? No, it won’t. They’ve heard it before. But if I can get them to think about what they might lose or how far they would have to get before considering stopping, then maybe I’m getting them somewhere. Closer to where I believe they should be. And this is only one of so many scenarios that I will encounter in primary care that require finesse in order to solve.

Everyone has heard from a nursing instructor or a textbook that nursing is an art, not just a science. But I wonder how many of us have lost that realization, who don’t acknowledge that what we do everyday requires intense problem-solving, creative solutions, and out-of-the-box communication? It’s more than giving meds on time, keeping people from dying, clocking in and out, and administering health advice as a provider. Being a good nurse or NP requires accessing that core creativity that each of us possesses and using that to excel at our jobs.

Some people probably doubt that creativity inside of them and that’s a shame. It’s part of what makes us human, relatable, and worthy of confiding in. But it’s true. Nursing is so much more than math and science. In fact, I would venture to say that nurses are some of the most creative people in the world.

60 Minutes for my Sanity

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On a typical day I only get 45 minutes, or 30. Or none. So honestly most of the time 60 seems near impossible, especially with a little one at home. But 60 minutes for what? To keep my brain, my heart, my soul alive. 60 minutes, taken in three chunks, to keep my sanity. I had gotten out of the practice of stepping back, away from my responsibilities and school work, to enjoy something that gave me life, something that would lend some perspective. But I’ve taken some steps towards balance over the past few months and I’ll explain why and how. And before you completely discount this post, like I would’ve, because I’ve already used the words “balance my life” and “perspective,” keep reading.

For the past year and a half now I have essentially been a stay-at-home mom with the caveat that I’m getting my masters online to be a nurse practitioner. In a few short weeks I’ll go skipping off to clinical three days a week and I’m sure I will miss my daughter terribly. I’m trying to soak up every minute that I have left with her this summer, knowing that this could very well be the end of my time as a SAHM, which is bittersweet for me. I’m looking forward to having a career and being a mom. A BOTH/AND situation.

But despite encountering the trials and joys of caring for a tiny person 100% of the time, I’ve always kind of laughed at the modern convention of “take time for yourself” as if this was akin to meditating for hours or using your “stressful” life as an excuse to splurge on pedicures and spray tans or go on golfing weekends. What mom has time for that? What working dad with a family finds this feasible? The terminology seemed frivolous to me; the ideas self-centered. I would gladly take the time to watch a show or read a book or, let’s be honest, simply take a shower, when my husband would offer but I couldn’t condone “putting myself first” on my own initiative if that meant neglecting some other duty (dishes, school work, laundry, phone calls).

But then something happened a few months ago that shook me up. It forced me to examine my patterns of behavior and thinking. And after some contemplation, I realized that while some of those patterns were productive, others were very destructive. Because of all of my denial of self, my masochist productivity, the giving up my free time for the betterment of those around me, I realized that I might actually lose my mind if I didn’t reorient myself within my day. I had lost the ability to get outside of the walls of my home and see the bigger picture. I had to change something. (As an aside, I think it may actually be MORE important for parents that stay at home all day with their children to do this as you never get a moment of your own. And, of course, the laundry will always be there so it can wait a few minutes, as much as that empty box on your daily checklist will haunt you.)

This episode of contemplation was essentially brought on by anxiety, by a culmination of stressors that poked me enough times in the side until I was forced to acknowledge it. It wasn’t even one big thing, just a compilation of small jabs that eventually festered into a wound that spread, infecting me with anxious thoughts and a depressed mood. I had to make some changes and that meant portioning out my time in small increments throughout the day to do activities that weren’t related to responsibility. 20 minutes in the morning, 20 minutes midday and 20 minutes at night. Hence, the total 60 mins.

I make my best effort to get up before my daughter wakes up. I attempt to sit on the couch, drink my decaf coffee that my husband made before he went to work, and spend some time remembering who I truly am. Sometimes this means reading the Bible, other times praying or journaling. Even a few times where I did nothing at all except keep silent. You can call it a quiet time or whatever else you want but it’s more than reading, more than learning. If I don’t remind myself of my true self- that I am a daughter of the King, that this world is at war, that God has called me for a purpose outside of solely being comfortable, happy and healthy- then I have already lost for the day. I will surrender to materialism and vanity, to productivity and anxiety. Although these shifts happen gradually and insidiously, they are vitally more dangerous and I have realized that without that 20 minutes in the morning, even ten, even five, then I am already running uphill and I will miss what God has for me.

My next twenty minute increment comes after I put my daughter down for a nap in the afternoon (or leave her in her crib for a few minutes if she refuses to nap). This is when I try to exercise and honestly I’ve been terrible at “making time for myself” in this area ever since my daughter was born. Some of it was health issues, some an insatiable need to do school work, but I realized that I didn’t need 20 more minutes of studying. I needed to take a break. So now I work out in my living room while I watch my stupid TV show and I try to let my body breathe, to exhale some of that anxiety that builds throughout the morning. Of course as a future primary care provider I highly suggest that everyone exercises at least a few times per week. There are endless health benefits as most people know, but they go beyond the physical. I had heard people talk about the benefits for mental health but I had never understood how vital that was until now- serving literally as my jolt back into the greater reality outside of what catastrophe will surely occur if she misses her nap today. I don’t have time to explain the physiologic ins and outs but exercise clears the head, suppresses anxiety, and energizes for the rest of the day. I have noticed that on days I don’t exercise, I feel apathetic, lethargic and irritable. Now, I can’t seem to go without those twenty minutes no matter what, like an addiction to something so good for me.

The last twenty minutes ends up somewhat fluid because this depends on our schedule and how tired I am but I try to reserve that time at night so do some reading or writing that’s not perfunctory. Fun reading. Fun writing. Stretching my creative mind, utilizing talents that threaten to go dormant, filling my soul back up for the next day. God without a doubt speaks to me through both reading and writing and it’s another way for me to communicate with Him during the day, just like exercise, just like my morning quiet time, giving the day a nice “full circle” feel. But really and truly, these things are essential to who I am. I can see my life more clearly; I feel like these are the moments when I really come alive amidst the daily chores and hassles. I look forward to it. I yearn for it. So I make time for it, even if that means taking a slightly later bedtime.

That’s it. It’s really not complicated and I don’t think there has been one day in the past few months where I have gotten the full hour spread out during my day. Life isn’t predictable and that’s part of the lesson- implementing structures that will be life-giving to you but also holding them open to whatever else God has for the day. Sticking rigidly to the routines will only worsen that anxiety that wants checked boxes and a clean house and this will spill over to your family, who ends up as the sad recipient of your dysfunction.

Call it “taking me time” or “a mental vacation” or whatever ridiculous terminology you want to use but it’s worked for me and I plan to continue it for as long as I can. And yes, sometimes that means getting a pedicure once in a while.

And just to nail home the importance of exercise, even twenty or thirty minutes of it, check out this amazing video on exercise. I think you’ll be impressed!

Let’s Be Honest, Going Outside is the Worst

 

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If you have children, I think you’ll agree with me: going outside is the worst.

I actually really like the outdoors. I’m not afraid of (most) bugs, I don’t mind getting my hands dirty or sweating a little bit and want my daughter to experience more of nature than she gets smack dab in the middle of suburban Dallas, Texas. Most of our vacations are planned around outdoor activities like hiking, camping, snow skiing or sight seeing, all revolving around beautiful scenery. Plus, I make a point of getting both of us (Evy and me) outside everyday, unless it’s raining cats and dogs or it’s August in Texas. I hope you can believe me when I say I actually do enjoy nature because what I’m about to say contradicts that.

The only reason I even thought to write this blog post is because of what ensured after Evy and I tried to go outside a few afternoons ago. After an hour and a half of not-napping (ugh! why!), I gave up and tried to think of something we could do to pass the hours until dad got home from work, something that would capture her attention and wasn’t TV. Oh ok, we’ll go outside.

First of all, it took us all of about ten minutes to get prepared to venture out two feet from our back door to our not-so-distant patio furniture. We had to go potty, fill up our water bottle, pick out a snack, and grab all of our gear, which consisted of a towel, a swimsuit, sunscreen, bug spray, two water bottles, a little potty, a roll of toilet paper, our hats, and my phone. I should’ve just surrendered early on and gotten a bag.

And goodness gracious, that was only the backyard. If we’d have gone to the “big pool” (the community pool) then add another towel, change of clothes, swim diapers, snacks, at least three toys, bandaids, a puddle jumper, and a portable potty seat (and let me just say that one piece swimsuits for potty-training toddler girls are simply a cruel joke played on parents everywhere). And I would spend the entire two hours chasing my child around, trying to keep her from committing pool suicide as she follows the big kids into deep waters or tries to run along a slippery ledge with her fat, toddler feet. That friend I invited? Yeah, we haven’t said a word to each other. She’s over there on the other side of the pool, trying to think of an excuse to leave too.

Back in my own backyard, it took another ten minutes of cajoling and threatening of consequences to get my two year-old daughter to be still long enough for me to apply sunscreen and bug spray. She fussed, a lot, and I honestly don’t blame her because I was literally man-handling her trying to get every crevice, every crease, every susceptible area of skin covered with sunscreen and bug spray. There will be no West Nile here today, no long-term sun damage, no dirty looks from another mom when I show up at Target with a sunburned child. (But wait, did I let her get enough sun to develop some vitamin D, the exact fifteen minutes like the pediatrician said? No, wait, she has Vitamin D added to her milk. But is it enough? Should I wipe her off for another five minutes of sunscreen-less sun exposure? Oh good Lord, who knows.) After it was all over, she looked like a very unhappy snowman, blanketed like a ghost in toddler-friendly sunscreen that cost me something like $16 at Whole Foods, and we were not on the best of terms.

So I finally settle into my patio chair and she gets to work on painting the side of our house in sidewalk chalk (…whatever) while I’m trying to convince her to get in the little, inflatable pool. Honey, it’s too hot to be outside without getting in the water. Look! The water feels so nice! You should really get in! Please, just get in for two seconds. One, two. Let’s count together! And she simply stares at me, completely unphased and unconvinced. I would never get a conviction.

Then I start getting really hot myself as I sit in the apex of Texas summer, watching her Jackson Pollock a work of art on our backdoor, wondering to myself if it’s completely inappropriate to have a glass of rose at 4:15 in my backyard alone with my child, when she informs me that it’s too hot and she wants to go inside.

Sure, honey. Why not.

In her defense, it really was unbearably hot outside and I was just as ready to go in, despite the fact that we spent a disproportionate amount of time getting ready to go out to the backyard compared to the actual time spent “enjoying” the great outdoors. But aren’t children made to go outside? Wasn’t it like only less than twenty years ago that kids lived outside, journeying across the neighborhood without parental supervision, completely oblivious of things like West Nile Virus or melanoma or kidnapping? You didn’t hear kids saying things like “but everyone else I know goes to toddler gymnastics or organized three-year-old indoor soccer camp instead of playing in the backyard!” They just got hot and sweaty and their mom got a break. Tough times, for all of us it seems.

Maybe I’m discouraged by the fact that we’re only starting to feel the weight of the 100 degree weather here in Texas, or maybe I’m just realizing that we’re going to have to pack all of our stuff up everyday and go the big pool if we want to be outside but either way I’m trying to make a joke out of my annoyance. To get a laugh from all the other moms who are thinking, oh my gosh, YES. Because, honestly, when did going outside get so complicated?

Despite my complaining, I don’t think there’s any way around it. Knowledge is power, and also mom guilt. I’m completely willing to blame social media and our overbearing, child-obsessed culture but I think it’s simply part of being a mom: indulging some of their whims and trying to meet all of their needs. We will never again live in a world without mosquito-borne diseases or melanoma but we’re doing our best. Fighting with a bottle of sunscreen in hand, taking on the world’s problems with organic, DEET-free bug spray.

I will admit, I’ve been the one to text some friends saying, “Meet up at the pool at 10? So much fun!” with several dolphin emojis like it was an impulsive, carefree decision rather than a calculated type-delete-type again type of scenario as I debated whether or not we actually wanted to go. Oh, the effort. Oh, the packing. Oh, what the heck let’s stay home in the AC. But I guess I’m here now to encourage all you mom that have found yourself in that moment that it is, in fact, very difficult to go outside, or do any number of other things with your kids. You’re not crazy or lazy or suffering from a debilitating disease that causes you to have sudden bouts of extreme fatigue. Disappointingly enough, most of those things are now intricately more complicated than they were twenty years ago but maybe it’s just a different world entirely. And all of us parents are trying to learn how to cope in it, in spite of it, in agreement with it.

Keep your head up, supernatural mom who decided to take all three kids to the pool on the hottest day of the year. Good job dad with twins who had no idea what he was getting into when he agreed to take on the toddler swim lessons. Let me give you that extra swim diaper when your child just closed down the pool. Hear me say that your child will only remember the fun times, and you’ll eventually start to believe that maybe it was worth it. At least, that’s the best we can hope.

I love my daughter and I like going outside. Blood-sucking bugs and eyeball-hemorrhaging diseases and cancer and 100 degree weather and all. So we’ll keep going even though, on some days, it’s the absolute worst.

 

Health Update: Entyvio

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We’ve had a fantastic summer so far- swim lessons and pool days and a cessation of some of our normal activities. In some ways this is difficult for me; I like routine and I liked having a few hours two days/week with Evy at Mother’s Day Out when I could get school done. But despite grinding through my second management class in NP school, I’ve enjoyed our transition to lazier days more than I had anticipated. It is nice to not be rushing out the door or adhering to a strict schedule. There is freedom in not having to obey a clock or a calendar and at this point, I only have one more real class left in NP school (I start clinicians in August!). It’s surreal to think that after two years of school work, I’m finally almost done with taking tests. Now I just have to stand in a room with a stranger and tell them what’s wrong with them. Actually, now that I think about, that’s way more terrifying.

There are many things I have on my mind to write about but I’ve had several people ask me lately about how I’ve been feeling on my new medication for my UC, Entyvio, so I thought I would update on how that’s been going. Just to catch you up, I developed antibodies to the anti-TNF agents (Simponi and Remicade) in January of this year, which was quite a blow since those medications have worked for me for years now. My doctor and I went through several options but eventually I got started on Entyvio, which is an intestine-specific agent that blocks one type of inflammatory mediator, one of the cells in my body that contributes to my disease progression and symptoms. It’s kind of a last-ditch-effort medication; there aren’t any others beyond this one for treatment outside of clinical trials. So let’s continue to pray that it works ๐Ÿ™‚

Entyvio is an infusion that I get at the hospital every 8 weeks. You have to start with three loading doses before you get to a therapeutic, or full dose, level. I achieved that therapeutic level about six weeks ago and ever since then I haven’t had any symptoms. Considering I was desperately ill only about six months ago, that is a huge blessing and a fantastic turn of events. I want to be thankful- there was no guarantee that this medication would work and so far it has been a great treatment option for me. If you want the full story, see this post.

But I often find myself ignoring my disease when I’m feeling fine, mostly because I get worn out. I get so incredibly tired of analyzing every internal feeling, every twinge of pain, when I’m in a flare. You cannot imagine how exhausting it is to premeditate every bite of food you put into your mouth, wondering if it’s ok or if you’ll suffer for it later. Some foods you know you shouldn’t eat, that’s obvious, but others are insidious, vague, and you can only see in hindsight whether or not it was a good idea. You never thought you would obsess so much about food and yet it becomes a major topic in your brain.

I deal with a lot of self-blame when I’m in a flare because I constantly wonder if I did something to bring it on. If only I hadn’t eaten that food. If only I hadn’t let myself get so stressed out. If only… It’s a very detrimental mental place to be and I’ve learned that at the least, it’s not helpful, and at the worst, it’s toxic. Being a Christian, I believe that God is in control of my body and ultimately my health is in His capable, loving hands. While I can do many things to affect my disease progression like stick to my diet and reduce my stress levels, the past several times I’ve gone into a flare there was nothing I could’ve done to change it. I can’t control cells and hormones or my colon. Therefore I also cannot live in that state of guilt and self-blame. It’s a ploy from the enemy to make me even more depressed in those moments, to make me forget that God is good and that He is allowing this trial ultimately for my good.

On the subject of modifiable risk factors, pretty much everyone knows that I believe in taking responsibility for my body and adhering to a diet that I feel works for me. At this point, I’m still eating a Paleo diet (no refined sugar, dairy or grains) ย but I’ve added white rice and the occasional sweet treat with no deleterious effects. Again, you have no idea how freeing it is to be able to go a restaurant and not ask a thousand questions about the spices or the glaze, to go get a natural popsicle with my daughter and be able to actually eat it. I’m still a huge proponent of eating clean but I realize that I can’t live my life relying on it to save me. It’s just a diet. God is the one who grants me healing or allows me to be sick.

In my cursory research on the internet I haven’t found many people who talk about Entyivio and that makes sense because it’s a relatively new drug and not many people are on it. I only know of one other person in real life who takes it. So I hope this helps anyone with questions and satisfies the curiosities of a few of you. Again, I’m thankful. I hope I’m entering into a season of…should I say it?…remission? Seems too good to be true but I’m going to trust that the Lord has heard my cries and granted me a period of respite so I can get on with my life, take care of my family, and blog again. Thanks for reading!

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Hypochondria of Advanced Medical Education (H.A.M.E.)

 

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Hypochondria of Advanced Medical Education (HAME) is an acute or chronic disorder that occurs when a person overreacts about his or her own medical problems due to an overload of knowledge about disease and dysfunction, distorting the ability to rationally process. Risk factors include being in healthcare, being a student in a healthcare field, having a type A personality, stress, and having comorbid medical conditions, although this can occur in people with no prior medical issues. It is most commonly identified in healthcare students, ranging from medical students, PAs, nurse practitioners and others and is the result of the constant inundation of comprehensive information regarding every disease known to man.

In this disorder, the student, instead of using rational clinical judgment and decision-making skills in diagnosing his or her own symptoms, reverts to a primal state of panic, throwing out the most likely benign diagnoses and instead attributing even the smallest of his or her ailments to catastrophic disease, nearly all of which lead to death. Of note, this only occurs for the individual herself and does not apply to her ability to diagnose others, except in the case of the student’s children, which only seems to intensify the symptoms. Usually the student can make accurate and rational diagnoses for non-blood related individuals but cannot apply those same algorithms for themselves or immediate family, leading to an internal state of disarray. The disease ranges along a spectrum with mild, moderate and severe insomnia-producing, worst-case-scenario-imagining, assumed-to-be-life-threatening forms.

Some examples include:

  • Diagnosing ankylosing spondylitis rather than mechanical low back pain (probably due to lifting a 27 pound toddler on and off the potty 25,677 times per day)
  • Diagnosing hypothyroidism instead of general life-related fatigue (see above toddler)
  • Diagnosing a pheochromocytoma instead of anxiety (see above toddler)
  • Attributing excessive thirst to a pituitary tumor instead of increased dietary consumption of salt (hyperphasia of snack foods related to said toddler)
  • Diagnosing Meniere’s disease rather than sporadic tinitus that only happened one time (I was just feeling plain crazy this day I guess)
  • Diagnosing cancer instead of about nearly anything else (because it’s CANCER. Yeah, I’ll say it again, CANCER.)

Only non-pharmacologic treatments are available at this time and include cessation of all activities that provoke the hypochondria including studying, mental rest in the form of binge-watching frivolous TV shows, margaritas, getting back normal lab results, and hearing a radiologist say “yes, you are actually perfectly fine.” Studies are currently being conducted on the use of Xanax for this disorder and counseling from a spouse has only shown negative outcomes. The only cure currently is removal of the individual from the healthcare setting but because this is unrealistic, studies show the next best treatment is completion of the advanced medical education. The disease seems to dissipate as the provider increases in skill and knowledge, although many providers never experience complete cessation of symptoms.

If you’re a family member of someone with HAME, there are support groups available for you, most likely in your immediate area. The best thing you can do to love and care for your family member is to support them during their education and let them give you as many physical examinations as they need to in order to feel that you are healthy and not dying of an obscure autoimmune disorder.

If you suffer from HAME, you’re not alone. I am sitting right there next to you, assuming I have gastric cancer instead of indigestion. But there is hope. There will be healing. And until then, stop looking up all your symptoms on UptoDate. Choose the benign diagnosis, even when it hurts. And keep up the good work studying. It will all be worth it in the end when you get those extra letters behind your name.

You will be worth it, including every single one of your moles that is not melanoma.

There’s a Hypocrite in All of Us

 

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I will admit that for the last ten years or so, I have been a bit of a hypocrite.

A few days ago I made my first primary care provider (PCP) appointment since saying goodbye to my pediatrician at 18 (I just turned thirty). I know, I’m in healthcare. I should know better.ย I realize that this admission also sounds odd considering I have a list of medical diagnoses a mile long (with the most random things, of course) but I have always seen specialists for my medical care since I was diagnosed with UC at 22 years old. It’s not that hard to imagine; you have specific needs and so you only see specific providers for those needs. But then other underlying, asymptomatic needs go untouched.

I currently have an OBGYN, a women’s health NP, and a gastroenterologist that I visit regularly. For the handful of times I’ve been sick in the past eight years, I have gone to the walk-in type clinic at my work (when I still worked there) or have just asked my GI to manage an issue that wasn’t directly related to my UC, although many of my issues have been. And since I have good relationships with each of them, I have managed to get by for the past eight years since I could mostly already tell them what’s wrong with me. It wasn’t a perfect system but I had made it work.

But recently, I’ve had a change of heart. I have seen a flaw in my rationale, my need for a primary care provider, notably my need for continuity of care. And this is slightly ironic and very hypocritical considering I’m training to be a primary care provider. I am learning right now to look at the full picture of a patient, to weave together bits of information about someone to create a healthier whole. I believe in having a relationship with a PCP. I believe in continuity of care. I believe in a holistic, comprehensive view of medicine. And I hope that I can show my patients the value of these things, whether in clinical soon or in practice later on. So, in an effort to be transparent, I’m admitting my ignorance here and repenting of my errant ways in hopes that you will not make the same mistakes that I have.

My first and most bland excuse is: Time and Money. I already go to a plethora of appointments. I think you can probably understand this one- I visit the GI twice a year or more frequently depending on how I’m doing, the OB constantly when I’m pregnant (I’m considered high-risk), go to the hospital every eight weeks for my Entyvio infusion, and have had to do several stents of weekly physical therapy for some lingering, childbirth-related issues. I am sick and tired of not only paying copays (hands up if you meet your deductible every year!) but of physically driving to all these appointments. And since I get my preventative care taken care of at my well-woman or OB visits, I haven’t feel the need to make yet another trip to an office. And, just for the record, most primary care is covered 100% by your insurance so my excuse really falls apart there.

My next excuse is: Fear. Dear God, if I get some routine labs drawn and find out I have something else wrong with me, I will lose my mind. Seriously. It’s sort of the mentality of what you don’t know won’t hurt you. Again, I KNOW. I’M GOING TO BE A PCP. IT’S A RIDICULOUS EXCUSE. Undiagnosed hypertension, as an example, hurts a lot of people who have no idea that their blood pressure is through the roof and now they’ve got end-organ damage. I often think about what I would tell myself if I was a patient. I can picture this entire scene perfectly- I’m sitting in a cushioned chair, my hands tucked politely in my lap as I listen to the person on the exam table, smiling gently as they relate the same excuse. I nod a few times, looking empathetic, not wanting them to feel judged or condemned for their faulty thinking. Then after they finish, I sit forward in my chair a little bit and reply, “I realize it’s hard to have to manage so many medical issues but coming to see me consistently will help both of us take better care of you, not only today but in the long run.” And then the patient will smile, trust me (hopefully) and keep coming back. So there, I just disproved my own point. I have no excuse for that one.

My last excuse is: DENIAL. This is very closely related to fear because one feeds off of the other. Here’s what I mean: It’s extremely difficult to look your disease or dysfunction in the eyes. To acknowledge that your body is broken, will only continue to deteriorate, and will not be fixed this side of heaven. I have known I needed to see the PCP for some other underlying issues but I haven’t wanted to admit that I need even more help. That I can’t control or fix myself. If you’re like me, you find every option to put your disease in a box, to manufacture a scenario (eating healthy or not drinking or any other modifiable risk factor) that will keep you healthy. But that’s not how it works. And it’s actually better for you and me both mentally and physically if we admit that we cannot cure ourselves (most of the time). There is freedom in seeking help and being honest, even if it’s with someone you don’t know. I hope that people will one day feel the same willingness to be open and honest with me. I pray that the Lord will give me the right things to say.

So there you have. I’ve been full of bs excuses but it’s time to shed those: to not fear the future, to admit where I am weak and need help, and to suck it up and pay those copays rather than getting that new purse. I need to take care of the one pathetic body I have, for myself and for my family. I hope I’ve convinced you that it’s worth it. Go find a PCP you like and stick with it. I’ll do it with you, I promise.

They Called and Said They’re Thankful

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In case you’ve been hiding in a hole away from social media for the past four days, it’s Nurse’s week. Coincidentally, Mother’s Day is also coming up (so a big high five to those of you who are wiping butts on AND off the clock!) You may not feel appreciated at your job, hanging antibiotics and suctioning trachs, wiping poop and dealing with dementia patients who are trying to escape. So I called a few friends and they wanted to express their gratitude. I hope this gives you the satisfaction you’ve been looking for.

That woman who had a husband, two boyfriends, and seven kids and made you update them all (separately) on the phone several times during the day? She called and said she’s grateful. That guy who kept making the crude jokes about nurses giving bed baths? He said thank you (and he’s sorry about that). What about the septic, schizophrenic homeless man who cussed you out for twelve hours while you titrated his Levo and ran his CRRT? He sent a note, very heartfelt thanks (oh, and he wanted to mention that he’ll be back.) And then there’s the belligerent family member who you had to call the police on. Oh wait, everyone else says thank you for that. The family member definitely does not. And then there’s your mom’s friend’s son-in-law. You remember, the intern who didn’t know a head from a foot and you successfully kept from killing anyone for an entire month’s ICU rotation? He’s a plastic surgeon now and he said you’ll be getting a thank you bonus check real soon. And you can’t forget the 400 pound lady who you had to push ALL the way to MRI, TWICE. And the family who asked you 46,578 times for ice chips. (sure, another cup? ok, well just wait a minute, I’m almost done. Can the pca get it? another cup, sure. it’s not cold enough? it’s crushed instead of cubes? it’s not made from fiji water? OH MY GOD DO YOU HAVE PICA?? LET’S GET A CBC STAT YOU CRAZY PERSON.)

And even if they won’t say thank you, I will. For all the times you’ve accidentally gotten splashed with urine a centimeter from your eye, or when that Flexiseal popped out a few inches from your face, or for all the times you’ve had to change scrubs during a shift- I say thanks. For every time you’ve almost gotten slapped by a delirious patient or bore the brunt of a family member’s exasperation with everyone but you, and for every time you got stuck with double isolation… I’m grateful. For every time you sweated through your underwear during that burn dressing change. For the fact that you can smell CDiff from a mile away. For all the TB patients. For all the times you had to travel with a TB patient. For every time the physician opened the wrong door to your TB patient’s room. You’re a rockstar. For comforting that medicine doctor who cried for twenty minutes after sticking himself during a central line insertion (the patient did have Hep C by the way.) For all the times you’ve had to politely say “just a minute!” on the portable phone to your other patient as you do chest compressions. For charting long past your shift. For all the times you’ve had to convince people that Webmd is not the ultimate medical authority. For the number of times you’ve gotten a unit lecture on CLABSI’s. For all the times your friends have texted you photos of their rashes. You’re killing it.

No one can disimpact like you. No one has trach suctioning skills like you. You’re a nursing gem, a diamond in the rough (or at least that’s what you look like most days). You get up at 4:45 am and get home at 8:15 pm. You can think of at least one shift where you didn’t pee. Your family has actually banned you from telling stories at the dinner table. You’re making it, and you’re doing a damn good job.

To the patients and families who actually do say thank you, we appreciate it. We hold on to those moments when someone is yelling at us in a language that we don’t understand or a physician rolls his eyes (yes, you were right. That patient did need to go back to the OR.) And to the ones who don’t, it’s ok. We’re tough enough. We know that what we’re doing is bigger than a thank you. But in case you haven’t heard it in a while, hear me now.

You’re a great nurse. And we’re thankful for you.

Here is the World.

 

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I’ve been trying to find the words for this blog post for a long time, actually long before I even stopped working at the hospital. Maybe it began when my daughter was born. I’ve talked about this shift before, the irreversible schism that happened in my soul once I had a child. My emotions expanded in ways I didn’t think possible; places of my heart that I had shut off became uncorked and years of suppressed feelings came pouring out like a waterfall. I changed and I started to think that maybe being an ICU nurse forever wasn’t feasible for me anymore, or at least desirable at this point in my life.

It really was a strange phenomenon. Suddenly with the addition of a tiny person in my world, all the pain and loss and heartbreak that I saw at work everyday and had been able to subdue, rose to the surface. I could no longer stuff it down or shut it away. My patients became real in a new way, as if blinders had been removed from my heart. Not that I didn’t care about my patients before; I just cared for them in an alternate capacity, one that closed me off enough from my emotions to be able to deal with these most heartbreaking moments of their lives. In many ways it had been protective and even beneficial. But I had lost that and it was making it very difficult to do my job.

All of my emotional volatility culminated when, a few months after I had returned from maternity leave, I was asked to take a fourteen year old boy who was most likely going to die from brain damage. By the end of my shift, we were coding him and I was staring at his mother’s face knowing that this was the end, for him physically and for her emotionally. It sounds very bizarre but I saw his life flash before my eyes in those last moments and all I could think about was how his mother had nursed him as an infant, chased him as a toddler, hugged him after his baseball games, and now held his hand as he slipped away. In that moment her pain became my own, tearing my insides in two, and I couldn’t imagine losing my precious daughter in the same way that she was losing her son. It was unfathomable. It was a tragedy. It was life and death. And I knew I couldn’t do it anymore.

Now, a year and a half removed from my ICU days, my life looks very different. I wipe a runny nose and fix lunches that my daughter may or may not eat, make a fool of myself chasing her around the playground and take the dishes out of the dishwasher day after day, the same actions on repeat. It is full of monotony and I can honestly say that’s been the best thing for me. I needed days where no one died. I needed to forget that terrible things happen to normal people everyday. I needed my most frustrating moments to be about getting Evy’s shoes on in the morning rather than running back and forth between two crumping ICU patients. I needed the monotony and it is healing me, helping to give me my perspective back.

I read this quote the other day and it quite literally blew my mind. I’m not sure why, it’s not complicated or verbose or even that eye-opening. But to me, it was profound and I’ll tell you why.

“Here is the world. Beautiful and terrible things will happen. Don’t be afraid.” – Frederick Buechner.

These few words stopped me in my tracks. Gosh, I wish you could feel what I felt when I read this quote. This man, Frederick Buechner, deserves my thanks because this was the truth I had been trying to say in many more words and had yet to capture. ย I realized why my soul had needed rest and monotony, how emptying the dishwasher day after day was the best kind of catharsis. Because I needed to remember that the world was full of both terrible and beautiful things. I had actually forgotten that.

As I transition to becoming a different kind of nurse, a nurse practitioner headed for primary care, I have started to grieve the loss of critical care. I realize that I probably won’t ever again work with patients on ventilators or draw an ABG or help run a hospital code. There are many things I will miss and many things I won’t. I think it’s that way with any job. But now I’m moving on to a less severe, although not less important world, wanting to try my hand at the flu and immunizations and much less life-threatening problems. It sounds boring in comparison maybe but I don’t think so. I think it’s exactly what I need.

There are a million different kinds of people in the world and, accordingly, a million different types of nurses. Some can work in the ICU forever, some stay in primary care their whole career. Some transition from one area to the next, taking advantage of the endless opportunities in this field. So where do I fall? Maybe I could’ve stayed in the ICU longer. Maybe not. But I chose to go a different direction, not because I got “burned out,” but because I knew what my soul needed at that time. I needed to be home with my daughter and heal from the very real tragedies that I had had the privilege of being part of for the past six years. After working in the ICU for almost seven years I thought I could handle anything, when in reality, seven years in the ICU is what I could no longer handle.

There is beauty in watching my daughter dig in the sand. There is beauty in being a part of someone’s last moments on earth. The important thing is that I remember that the world is full of both. Beautiful, terrible moments. And everything in between.