The Little People in Life

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Yes, it’s been forever since I’ve done a blog post. There are multiple reasons for this including finishing a whirlwind summer of clinical last year, graduating, having another baby, staring a full time NP position…etc. And I won’t promise that I’ll blog again anytime soon but I’d like to tell some stories now and then. I’ve had one story in particular on my heart and I want to share it because it links many pieces of my life together and illustrates how the most difficult things can turn into the most stunningly beautiful moments.

Last summer was one of the busiest seasons of my life. From May until August I was working 4-5 days at clinical per week along with 1-2 hospital shifts on the weekends. Yes, when you do the math it adds up to around 60 hours/week. There was a point where I didn’t have a day off for fourteen days straight. There was nothing I could do to change it. The hours had to get done and the shifts had to be worked and so everyone in my life put their big people pants on and we made it happen. My husband did all the household tasks, my mom helped take care of my daughter, and I powered through like a long-distance runner, focusing on the next step, the next day, afraid to look too far back or too far ahead. (Then I had to stay up every night entering my clinical logs thinking, WHY IN THE WORLD DOES THIS TAKE SO MUCH TIME? That’s a different blog post, though.)

Add on the fact that I was, oh yeah, pregnant in my third trimester. Yes, that’s right! I was giant pregnant, waddling around on swollen ankles as I pretended to be a nurse practitioner on weekdays and knocked out some ICU shifts on the weekends. People would often stop me and ask, “how in the world are you doing all of this?” and I would simply answer, “I have no idea.” Because honestly, I didn’t. I still don’t. God put the path in front of me and He made a way for me finish it. I have no better explanation than that.

Thankfully, my little guy was a trooper even in the womb. I had a breeze of a pregnancy and worked past forty weeks. (I took and passed my boards at thirty eight weeks and three days if you’re in the mood for something that might cause you have a panic attack. I burst into ugly, giant tears the moments the lady at the testing center handed me the paper that said, “passed” and everyone let out a high sigh of relief that I hadn’t gone into labor during my test). My little guy kicked and punched and learned how to be a NP right along with me like my own little stowaway. And at the end of it all, on my last day of clinical I went home and got promptly sick with a terrible cold, as if my body had been waiting until I was finally done to shut down. But we made it.

This point of this dramatic re-telling of my summer is not to look for some validation, not to search for pats on the back for making what seemed impossible possible. No, the point isn’t about me but it’s about my daughter, Evy. She is one of the real heroes of this story, the real trooper, and she deserves some praise for all that she had to go through last summer.

I’ll cut to the best part of the story. On the day of my hooding (a nursing tradition for graduate students, akin to graduation) the three of us (Evy, my husband and me) got up, got ready, and got in car. We drove to the campus. I put on my robes. And they snagged a seat in the auditorium. We all had to wait a long time as rows and rows of other graduates passed before me, each one waving wide, stunned smiles just like the one I had on my face. Family members were shouting out from the audience, some of them yelling things like, “that’s my wife!” or “that’s my sister!” garnering laughs from everyone in the audience. I sat in my seat thinking how surreal it was that I had finally, after three years, made it to the end of this journey and how miraculous it was that I was still healthy and pregnant. It all seemed like it had been too hard to be real and now too good to be true.

My turn came and I wobbled up the steps in line with the other FNP graduates. I waited for my name to be called and finally someone with a pleasant, punctual voice announced, “Natalie Bridges.” I had been trying to spot my family in the crowd but hadn’t been able to find them yet. I knew they were out there but I didn’t know where to look so I scanned the crowd as I walked across the stage, nearly blinded by the spotlights. The whole thing felt like a dream, like one of those moments that you know you need to remember but you still feel like is slipping through your fingers.

And then, just when I had given up on finding my family in the crowd, from the middle of the auditorium I heard a tiny voice that I recognized. It was the same voice that had asked me every night after work to, “tell me about your patients!” The same voice that had instructed me how to do check-ups on stuffed lambs and owls and baby dolls. The same voice that had never said an unkind word about me having been gone so much that summer, that didn’t know how to hold a grudge, that gave nothing but love to her mommy who was struggling to juggle so many balls at one time. And that little voice shouted, with all the pride she could muster, “that’s my mommy!”

As soon as I heard her I knew it was the last straw for my fragile emotions. I burst into tears, right there on the stage, completely forgetting what I was supposed to do as I walked toward the instructor at the other end. Evy’s voice was surprisingly loud in the midst of the crowd, carrying so far that the whole audience laughed. The instructor whispered in my ear that I had to lean down so that she could place the hood over me. I obeyed her, tears streaming down my face. And then Evy shouted it again, even louder this time, with her own little determined fervor, as if this was a message that could not get missed. “That’s MY MOMMY!!”

And as my heart ached with love, shreds of myself spilling out through my tears, all I could think was, “this is it.” This is why I did all of this. Yes, to help people. Yes, to find a fulfilling career. But what could top my little girl being proud of her mommy? She was telling me, and everyone else, in her own little way that I had done something valuable and that I was valuable to her. It was a thank you I hadn’t expected and one that I will never forget.

I will hold onto that day in my heart for the rest of my life.

She’s still offering me so much grace as I now work full time as a nurse practitioner. I’m away more during the week but home every night for dinner to tell her all about my patients, to teach her all my “diagnosis’s” and to explain, yet again, why patients don’t need antibiotics for a cold. She’s full of excitement and creativity and promise and I hope that I will inspire her to do something daring with her own life. She’s the encouragement that I still need as I take a step into a career that still feels very foreign and overwhelming.

It really is all about the little people in life. This precious daughter of mine who can already, at only four years old, do a dang good physical exam, and my little son who makes me feel like the most important person in the world every time he looks at me with those big, blue, inquisitive eyes. They give so much grace, so much love, and without them everything I have gone through in the past few years would have an entirely different meaning.

I enjoy my patients; I enjoy my job, but in the end, that little voice from out in the crowd means more to me than anything else in the world.

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May FNP Update

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The days are flying by but here’s another update on school, life and baby…

Baby #2: If you follow me on social media, you saw that we announced some super exciting news a few weeks ago…we’re having another baby! And it’s a boy! We’ve kept this news to ourselves for a while now but after I had a healthy report at my 20 week sono and we found out the gender, I figured it was time to share. I’m due September 1st, which is about 3-4 weeks after I finish my master’s degree. Good timing? Bad timing? I guess only time will tell! Either way we’re super excited to welcome this little man into our world. For several reasons I thought we would end up with all girls so this news was probably the best surprise we’ve ever had (along with meeting Evy when she was born!) I’m starting to wrap my mind around the fact that I will be a BOY mom too. The thought of having two sweet babies in the world brings me to tears daily and I absolutely cannot wait to meet him and for Evy to meet her little brother.

Pregnancy: This pregnancy has been vastly different than my first and now that we know we’re having a boy, it makes sense. Thankfully I was on a break from school during my first few weeks because those were ROUGH. Nausea, severe exhaustion, and a general feeling that I might die before I make it to twelve weeks. But that passed and now I’m dealing with a whole host of ailments that never happened to me with my daughter- melasma, leg swelling starting at 12 weeks and erythema nodosum. (GROWING A HUMAN IS HARD WORK) Despite all of these things, baby is doing well and I seem to be doing fine working all these hours. That brings me to the next topic…

School: I FINISH IN LESS THAN 90 DAYS. I am in my LAST semester. Yes, this is true but it does not yet feel real. I’ve been in school for almost three years now and I cannot imagine a day where I’m not pouring through books or scheduling clinical shifts. I will definitely be a life-long learner (you have to be in the world of medicine) but it will be so freeing to get to the end. To see the completion of everything I’ve worked for. To simply work normal hours again. So until August 10th, I need all the prayers you’ve got! My calendar is full literally everyday and if I look at it too long, I start to get short of breath. It’s going to be a tight squeeze to get 360 clinical hours in 13 weeks along with my 24 hours per week at the hospital. Honestly I don’t know how I’m going to do it but the Lord hasn’t let me down yet and I’m trying to let go of my control (or lack thereof) and trust Him.

Work: I’ve been back in the ICU for a while now and it’s been both easier and harder to come back than I had imagined. What about it has been easier? Well I haven’t been nearly as worried about leaving my daughter for those long hours as I was when she was a baby. This makes sense because she’s three and way more independent and she’s usually awake when I get home from work so I can help put her to bed. When I went back to work after she was born it really tore me apart (hence quitting for a while). I was constantly worried about her and it took a toll on me. Now, I don’t have any of those worries and thankfully I still get to see her everyday when I get home.

What’s been harder? Well the patients haven’t changed and although I’ve had to pick up on the few new things that have come into effect over the time I was gone, for the most part being an ICU nurse is the same. People still come in crazy sick and you still work to make them better. The hardest thing has been going from being one of the more experienced nurses to feeling back at the bottom of the totem pole. I spent seven years cultivating skills, relationships and a level of respect that kind of evaporated while I was gone. Now there are a ton of new staff who don’t even know me and it’s humbling to admit everyday that I don’t know all the answers anymore. (Essentially I feel somewhat incompetent at work AND at clinical- ha, fun times).

Nevertheless, I’m glad to be back working with patients. It’s funny how my mindset has shifted now that I’m much closer to being a provider. Instead of just giving the diabetes medications, I wonder why the providers chose that drug or that dosage or why they ordered one lab test over another. I find myself correlating patients that I see in clinic with ones in the hospital because many times it’s simply a continuum of care. My patient in the clinic has super high triglycerides that we’re trying to control and my patient at the hospital was hospitalized for pancreatitis due to high triglycerides. In short, many times I’m seeing the beginning and the end, the first signs of trouble and the extreme manifestations of that trouble. I wish I could take pictures of my ICU patients and use them as motivating factors for all the people in clinic who won’t agree to make changes. (Do you want THIS to happen to YOU??) But that would be both illegal and terrible so I won’t!

Preparing for boards: My birthday was a few days ago and I told my husband the two things I wanted to do were exercise and study because those are activities that I hardly have time for anymore! I did get a pedicure and go out to dinner so don’t think I’m completely lame. Still, I wish I had more time to pour over my review book. THERE ARE SO MANY THINGS I DON’T KNOW YET. Or things that I have forgotten over time. So many lab tests. So many obscure diagnoses that need to be on my differential. So many medication side effects. Sick people are complicated? Yes. So extremely complicated. I’m taking a board review class in July because I think it’s essential regardless of the fact that it’s inconvenient. I’ll be missing two potential clinical days and the class wasn’t cheap. But I believe it’s worth it so I’m making room in my life for it.

The reality is that I’ll probably pass the boards but I will still feel like there is a knowledge gap. I’ve heard this from all new NPs. So all I can do is surrender to that feeling of incompetence and use it to continue to learn and take better care of my patients. I’ve come to accept that much of what I need to be a good NP is exposure- hours logged seeing patients. Expertise comes with time and the more hard days I have with difficult patients, the more I’ll remember everything I need to know. Essentially, it’s important for me to continue to mess up because that’s how all of this will get solidified in my mind. That’s a hard pill to swallow when you’re one of those people who wants to get everything right the first time!

Have you had enough? My husband and three year old have been my biggest fans. My husband is rearranging his schedule for the summer so he can home more with our daughter and my mom and MIL are signing up for days to play with Evy. Evy goes around telling people that she’s a nurse practitioner and I can’t stand it I’m so proud of her. Hopefully she will be proud of me too!

I’ll try to post another update in June. Thanks for reading!

April FNP Update

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Goodness, it’s been a long time since I’ve blogged. When I decided to resume blogging I had the best of intentions in chronicling my journey towards FNP but something got in the way. A lot of things got in the way. SCHOOL mainly. So instead of crafting an eloquent blog post about some existential nursing concept, I’m going to give you a stream-of-consciousness update and be satisfied with it because I’m already working on borrowed time. There’s an open review book waiting for me, scolding me with all the facts I do not yet know about rheumatoid arthritis. And you DO NOT want to ignore rheumatoid arthritis.

So what has been keeping me so busy for the past few months?

Working! What in the world do you think I’ve been doing?

I’m currently finishing up my second-to-last semester in my FNP program with a tentative graduation date of August this year. (OMG DID I REALLY JUST WRITE THAT?) I’m over a third of the way done with my total hours and the days seem to be flying by. As my cumulative hours sheet grows longer and longer, I grow one hour closer to freedom. One. day. at. a. time.

Clinicals have been an unexpected success- not that I always make the right choice, believe me, I’m made some epic blunders- but I am enjoying it more than I ever thought I would. The patients are wacky as ever, the complaints are unpredictable and varied, and the physical exam findings sometimes make me put on my ICU nurse face so that I don’t show that I’m HORRIFIED BY YOUR FEET RIGHT NOW. Or, I’M HORRIFIED BY YOUR LAB VALUES. Or, I’m HORRIFIED BY YOUR NON-COMPLIANCE. It’s the same face I put on in clinic when a patient asks me to look at something I never thought I’d see in a place I never thought I would have to examine. Primary care is awesome, never boring, always full of characters. It’s definitely where I want to be as a nurse practitioner.

Plus, sometimes I do make the right choice. I pend an order and then my physician says the exact same thing I just put in the computer. But I did it before he said anything! I proved to myself that I actually know something! I CAN take care of patients by myself! This victory over putting in the correct dose of valsartan (big time stuff, people) lasts for a brief period until I completely forget to address his preventative care needs or forget to ask him what his home blood sugars are or try to order two serotinergic drugs at the same time (gasp!). Then I come back down to reality and remember that I still have plenty of hours to go but that those small wins are not insignificant. I am learning and I am going to be the best NP I can be (insert girl scout wink).

Other than clinical, I’m working two shifts a week at the hospital in the ICU seeing the end result of all these complications that I’m trying so desperately to control in primary care. I’m also studying for board exams, going through my review book slowly, trying to jam all the details into my brain about lab testing for Hepatitis B and the difference between gout and pseudo gout (who gave them those names? Can I punch that person in the face?)

Oh and I have a husband and a daughter who like to see me once in a while when I’m not off saving lives acutely or saving lives preventatively (see self-inflamed pride above). In all seriousness, my family has been amazing throughout this entire process. My husband adjusts his schedule, cooks, does laundry, picks up my daughter and even scheduled me a nail appointment the other day after I thought I was going to lose my freaking mind. Even my daughter has been flexible in her own three year old way, telling me that she’s going to work at the children’s hospital while I go to work at the big hospital. She sends me a toy everyday in my bag so that I “have something to play with while I’m at work.” A big part of me is doing this for them and I couldn’t do it without them.

A few quick resources I’ve found helpful along the way:

The Curbsiders Podcast– If you’re going to be in primary care, you need to listen to this STAT, every episode. Seriously, you should’ve started yesterday. I have (more than once) pulled out an expert answer based on something I recently learned in one of the podcasts and impressed my physician with my vast knowledge of obscure details (yes, my preceptor DEFINITELY thinks I’m smarter than I am). The podcasts are funny, entertaining, and chock full of useful information. Plus, no one from your school is holding a letter grade gun to your head to do it, so the freedom to listen willingly is a plus.

This review book– There are several good review books out there but this is the one I got attached to so I’m talking about it. If you’re just starting FNP school you might want to get through the first few classes before you break it open but this is what I use to study and I wish I would’ve started reviewing it before I started clinicals. Most of the sections are short enough to where you can do it when you have a small sliver of time.

AAFP articles– After I read about a section in my review book I usually look up a AAFP article on the topic to give me more information and solidify what I’ve learned. The articles are simple enough to read and can usually be scanned quickly for the highlights. Top notch, in my opinion (my opinion that literally means nothing to anything).

That’s enough for tonight. I’ll try and share more consistently, even if it is short and sweet. There’s a part of me that comes alive when I’m writing and it’s especially important that I don’t let that flame die out under the oppression of my schedule and upcoming board exam. It doesn’t help anyone if I graduate in August as a talking shell of a FNP who can’t remember how to type her own name.

Thanks for reading!

 

 

 

The Plague

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I believe there is a plague that exists within healthcare, something that I would say is worse than burnout, more devastating than compassion fatigue, and more debilitating than job dissatisfaction. This plague is insidious, internal, individual and communal, and often goes unaddressed for far too long. It has affected me personally, changing the way that I view not only my job but also my own life, seeping into every arena of my mind, contaminating my ability to deal with suffering. I often hear people discussing a host of other issues as they try to determine the problems that our healthcare system faces but I don’t hear many people talking about the plague that I deal with on a daily basis. Maybe someone out there has a solution or a way to deal with it but in my nine years in nursing I have barely heard a whisper about it.

I’m writing today in hopes that I’m not the only one who has been infected.

I heard a speaker the other day talking about trauma. I was expecting the lecture to be about patient trauma, aka the trials that they encounter in life before coming to the hospital. At my facility most of the patients are disadvantaged, economically strained and have had to face dramatic challenges in life. The speaker did briefly address this topic but then she took the conversation in a direction that surprised me. She expanded the definition of “vicarious trauma” to apply to those of us who witness horrific things everyday at the bedside and then have to figure out how to structure our lives around it. Basically she asked the question that I’ve struggled with for years- how do we come back to work day after day, shift after shift, after seeing such potent suffering and death?

To put it lightly, her words struck a nerve with me. I’ve fought to put words to this concept for years now- the idea that I am forever changed because of what I’ve experienced as an ICU nurse. And I’m justified in wanting answers to these questions, of wanting to deal with this plague, because the horrors I’ve gone through are not insignificant.

I’ve watched fathers bleed to death in front of their children. I’ve seen young men become quadraplegic after hanging Christmas lights on their own suburban houses. I’ve watched young mothers hemorrhage to death after a catastrophic childbirth. I’ve held the hands of parents as they let their adult children go after they attempted to blow their heads off with firearms. I’ve seen more attempted suicides than I ever even thought possible. I’ve watched helplessly as we’ve adhered to family wishes and coded little old ladies, cracking their ribs as they flailed like ragdolls on the bed, knowing we would never get them back. And this is not specific to the intensive care unit. No matter what area of healthcare you work in everyone has a story that they would classify as “the worst thing I’ve ever heard.” I’ve seen things that I can never forget and gone through emotions that I wish did not exist.

And yet we go on because that’s what we do in healthcare. But then we’re left to figure out how to categorize and deal with these traumatic experiences on our own. We’re left to figure out our own answer to “how do I come back to work tomorrow?”

I’m not saying that facilities and organizations are not trying to help healthcare providers work through these issues. I know there are support groups and free counseling and a host of other options. But, speaking as a nurse, I also know that nurses are probably not going to be too apt to take advantage of these resources because we pride ourselves on being able to do the job with a straight face and come back the next day as if nothing had happened. We develop callouses of the heart, probably to keep up from getting infected in the first place. I know this because that is how I’ve operated for years.

So why did I start to face this plague in the first place? Because I hit a wall. The experiences I had gone through had shaped me, whether I realized it or not, and I could no longer ignore the behemoth in front of me. I had seen so many horrible things that I started to assume that everything was worst-case scenario. In my mind, nothing could ever be a minor accident, only an accident that led to death, dismemberment or paralysis. I had no middle ground anymore, no rationality, and a very-present fear of something terrible happening to me or my family. I realized I needed to deal with my issues. I also realized that I needed to find the root cause if I had any chance of coming up with a solution to my vast and overwhelming problem.

You might be thinking that I’m just one of those people who is prone to feel anxious, prone to worry. And you would be right. But you can’t attribute this entire plague to personal tendencies. I know men, women, new nurses, veteran nurses, physicians, respiratory therapists….and the list could go on. And they all have felt this way at some point. At some point everyone wonders why in the world we keep coming back to work.

So we’ve narrowed down the major question but finding an answer is a much more difficult task. How do we process these experiences in a helpful way? Do I just live in fear of something horrible happening? Do I try to rationalize my emotions and keep telling myself that I’m overreacting? Do I quit healthcare altogether?

I don’t have the answer, even after years of searching, but I can tell you what I’ve learned along the way:

The first thing I had to do was realize that the world is full of suffering and there’s no way around that. Ironically, I learned this lesson as an adult through both my own experiences and the experiences of others. Unfortunately many people learn that the world is a bad place at a very young age and they grow up with an understanding of this truth. Mine was acquired and left me feeling like I had been lied to all of my comfortable life.

Another thing I had to accept is that the world isn’t fair. I wanted life to operate in some predictable manner. For example, I adhere to the rules, I play nice, I strive for honesty and integrity and things will work out. Seems plausible, right? Only to someone who hasn’t lived in the real world. The nicest people get fatal cancer and the most horrid people in society recover without a scratch. That’s just the way it is sometimes.

So the world is full of pain and suffering and it is by no means equitable. I accept that life is fragile and I have only a miniscule amount of control over it. Well now I’m just depressed and left with a nihilistic viewpoint that robs me of any motivation.

That might be true except here’s another thing about nurses- it’s hard to keep them down. When they hear something impossible, they want to do whatever it takes to turn the situation upside down. They don’t give up. They don’t back down. Nurses are the definition of making lemonade out of lemons. Healthcare providers sacrifice their own time, their own lunchbreaks, and even their own health sometimes to make sure that others are taken care of.

If there is a plague, then there are people fighting against it. When there is trial, individuals always rise to the task. And so I decided I had to do the same. I had to find a way to fight back against the sorrow, the heartbreak, the unfairness of it all.  I came to terms with these realities and then decided that my only method of fighting back was to do my job to the best of my ability and to push back the darkness one kind word or one hug or one smart clinical decision after another. I decided to face my fears, knowing that I would still be impacted by the trauma of others but that I was actually trying to turn the equation in a positive direction. What else can I do? I can’t change what has already happened to people but I can change how it goes from here.

This is my working thesis and it is still very much in progress. I don’t have the answers and I still have days when I feel an overwhelming amount of pain for the people I’ve taken care of that day. But I know I’m not the only one who has had to make a real, all-encompassing effort to deal with the things they’ve seen. We all have and we need to see the good we’re doing in the midst of all the sadness.

For every tragic story, there is a family member who leaned on you to get through it and they will never forget your kindness. For every unfair circumstance, you have made a good call that benefited your patient. For every time you’ve wanted to cry at work in the supply room, well, you’re justified in letting out that emotion. Your job is not in vain, although it seems like it sometimes. And there is a reason to come back tomorrow. The darkness is real and weighty and potent but it does not have to win.

We won’t let it.

 

 

The Weight I Cannot Carry

Carefree woman arms outstretched on the mountainIt drives me crazy sometimes that I really don’t have control over anything.

I see this everyday as a nurse and it often makes me feel powerless. I can hang all the antibiotics in the world but I cannot cure someone of ARDS. I can hope that this patient doesn’t have to go back for more surgeries but nobody, not even the surgeon, can say 100% that it won’t happen. One inch to the right and the bullet would’ve killed him. One inch to the left and he would’ve lived. I can do everything in my power to help save someone and they can still not make it. I can tell a patient a million times over to limit alcohol consumption but they can refuse. And then they could die in a week or live to be ninety, who knows? For all the miraculous interventions that we’ve come up with in medicine, many, many aspects are still out of our control. And while we all intuitively know this, we ignore it most of the time. We want to be the masters of our own fates, and our patient’s fates as well.

The randomness can be terrifying, the fact that we have no control over the majority of things that happen. This man was just walking down the street and someone shot him. This lady was minding her own business and someone stabbed her. This child was living a healthy life and now has cancer. This can breed fear like wildfire in your life if you let it, if you don’t find some way to combat these thoughts. You have to find a balance, the line between defiance and acceptance. Resignation and initiative.

I’ve recently gotten a taste of this lack of control in my own life. A week before Christmas my NP preceptor for January informed me that she was leaving her practice and basically wished me luck in finding a new one. Being only a few weeks before the start of my semester, you can imagine how I felt about this news. I threw a big fit (not to her), if I’m being honest. So now I’m going to have to defer the start of my semester and I’m scrambling to find a new preceptor on such short notice. It’s frustrating and discouraging and I hate that there’s a big hole in my perfect plan now.

I have absolutely no control over the fact that my preceptor decided to leave me with no options. I can’t fix the fact that I have to wait six more weeks to start my clinical semester. I can blame everybody and everything in the world but that won’t change the outcome. It’s out of my hands. But as maddening as that is, I’m starting to accept that this is how life works. Plans don’t work out. People get unexpectedly sick or laid off. Storms hit and car wrecks happen and pregnancies don’t make it. This is the reason why hospitals exist! I can fight against this and I often do, but it’s futile. I exert very little control over anything in life and yet I still try very hard.

To be fair, sometimes the uncontrollable turns out to be good news. A positive pregnancy test or an unexpected promotion or an accident that turned out to be a fender-bender when it should’ve been worse. Just as many bad things are out of our control, many good things are too. And there’s hope in that. Without that juxtaposition, I think we’d all give up and live meaningless lives. This is the reason why we hope for remissions and good lab results and why people work in labor and delivery. Sometimes life unexpectedly throws you something joyful.

There are a million insidious questions that I believe every healthcare provider has to face at some point. Questions like: Why do bad things happen? Why did this person die and not this one? Why is everything so out of our hands? How much impact can we really make as healthcare professionals? How much should I push and how much should I leave it be?

Obviously we believe that our words and actions carry some weight otherwise we wouldn’t show up for work in the morning. I can’t make someone get a screening colonoscopy or a mammogram but I can inform them of the benefits and risks, try to convince them that it would be good for their health. I can rejoice when someone decides to quit smoking at my advice. But sometimes I will also have to lament when someone refuses to take their insulin and ends up with an amputation, despite my admonitions. I will never give up advocating for wise choices because it’s not all up to genes or luck. We are still responsible, while not being in full control. We have to become comfortable with this oxymoron, as frustrating as it is.

Control will often fail us for another reason. People are allowed to make their own choices, even bad ones. They’re allowed to sign out AMA and ignore medical advice. They’re entitled to refuse that surgery or to keep doing IV drugs. They don’t have to listen to and follow your advice. People are not black and white and neither are their motives, choices and responses. You can’t control the heart and as healthcare providers, that should never be our aim, even when you see the train coming full speed down the tracks for someone.

For me, it comes down to humility. I have to accept that many things are out of my control. I don’t control the universe. I don’t control my patients. I can’t control many aspects in my own life! I can kick and scream about all of it or I can resign myself to do the best that I can- promoting smoking cessation and praying for that sick ICU patient and hoping for a good outcome. But then I have to leave it. I can’t live my life in paralyzing fear of the unknown but I also can’t think that I can control every outcome.

The only thing I can do is decide not to carry that weight on my shoulders.

I don’t know the answers to the questions. I don’t know why this person was allowed to live and this person’s life was cut short. I will never know why this person smoked for forty years and never got cancer while this child died of leukemia at two years-old. I don’t know the answers, but I think it’s still worth struggling with the questions. Even if we don’t find answers, we find out something about ourselves. We discover why we get out of bed at the crack of dawn and go to work day after day. We remember why we spend hours in surgery. We realize why we always, without fail, mention smoking cessation at every visit. We don’t limit our tears when someone close passes away. We learn to embrace everything that comes, in full measure, the whole spectrum.

We learn to live in an unpredictable world- to rejoice over the good and mourn over the bad and appreciate what is in front of us. We learn to embrace both joy and pain, exaltation along with sorrow. We learn what it means to live openly and humbly. We learn not to fear tomorrow no matter what it holds. We learn how to truly love, even with no guarantees.

We learn what it means to be human, the full messy whole of it.

And that is the best thing we can do for our patients, and ourselves.

 

The People Fade, but the Stories Do Not.

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In 1957 my grandmother received her nursing pin as a graduate of a diploma nursing program, in the era before the emergence of formal nursing education. Nine years ago my grandfather gave me that pin when I graduated with my BSN and now the pin sits in a pretty box in my room like a treasure, something full of lost memories. It’s grown tarnished over the past sixty years, fading to a dusky golden color that has lost it’s original sparkle, but every time I look at it, it grows in value. That pin has become a symbol to me of many truths- that my actions are bigger than me, that legacies really are something to strive for, even in our culture that seems to think that nothing lasts, and that this profession will never die. The pin has meaning to me now because I ended up with the same job title and because I know how hard she had to work for it. How much she had to sacrifice to be a nurse. How I benefitted from her perseverance.

Although I don’t know a whole lot about my grandmother’s story, I know that she worked on the weekends while my grandfather watched my mother and her sister. I know she wore white shoes and a white hat to accompany her white uniform. I know that she worked at a psychiatric facility, probably straight out of One Flew Over the Cuckoo’s Nest. I know that she was a kind, caring person who loved her family and I can only assume loved her patients in the same way. She passed away when I was in middle school and I wish so badly that I could hear her stories, that we could go out to dinner and that she could tell me the honest truth about what it was like back then. The good, the bad and the ugly. I think I’ve been in the trenches in the trauma ICU but I’m sure she could beat me by a long shot. Working in a psych facility in the 50’s automatically trumps any crazy stories I could tell.

What’s the point of this? Yes, my grandmother was an amazing woman and she should be honored as the first nurse in my family and a contributor to my own career path. But I’m getting at something else. We all have nurses who stand out in our mind, those who have worked extremely hard to love people day in and day out, those people who have impacted you in a significant way. Some of those people are memorable because they’re valiant soldiers who braved bedside dangers and trials, maybe even on your behalf. Others remain lodged in our memory because they were crooks and narcissistic thieves, people who spread shame like a contagious disease across the great name of nursing. Most of us have interactions with a plethora of people but there will always be those who left a mark. Here are a few of the memorable nurses in my life, for both good and bad reasons, and I’d love to hear your thoughts on the nurses who have impacted you.

  1. My very first preceptor as a new graduate in the ICU– I spent the better part of the five months wondering whether she actually hated me or not. She was a fireball, always looking over my shoulder to correct me, always pushing me farther than I thought I could go. I had more than one day where I disappeared into the supply room to cry. She made me take patients that I thought were out of my league, assigned us to double isolation to learn clustering my care, and gave out smiles like rare jewels, reserved only for special occasions. I couldn’t wait to graduate and be free from her. It wasn’t until I started precepting new nurses myself that I realized how great of a preceptor she had been, for stretching me while I was still young and under her care, for actually caring how I turned out as a nurse.
  2. Night shift nurse who scared the crap out of me as a new grad– On one of my first nights on my own after graduating from my ICU nurse residency program, I was assigned to a patient. My patient happened to be positioned next to the patient of a scary-looking night shift RN. She was unknown to me, with bags underneath her eyes and ratty, nasty hair. Her eye liner drooped haphazardly down her face. She told me weird stories about her daughter as I tried to escape her and do my work. And then she told me that nobody actually gives the insulin prescribed on the sliding scale protocol. What good does 2 units actually do anyone? she argued. I politely disagreed and spent the rest of the night avoiding her, terrified of what else was going to come out of her mouth. She got arrested and fired for being high at work only a few weeks later.
  3. My mother’s friend who let me shadow her in high school– As a junior in high school I was fairly certain that I wanted to work in the ED or ICU as a nurse so one of my mother’s friends let me shadow her for a night in the ED at a major hospital. I borrowed a pair of scrubs and fastened all the bravery I could muster as I walked in to the hospital with her that night, having no real idea what I was walking into. I pretty much failed at being helpful, even at taking a temperature, and I almost passed out when we received a trauma patient who had been thrown from a horse. But I walked out after that experience feeling like I had found my true calling, a job that was hard-core and exciting and would push the limits of what I thought I was capable of at that time. I followed that dream and have always been thankful that this nurse took the time to show a high school student what nursing could look like.
  4. The nurse that made me almost have a heart attack– one night when I was a new grad, another nurse told me that I was getting a level one trauma hit in my empty bed. I had never taken a level one on my own and I was literally speechless. He told me to get the rapid infuser and a few other pieces of equipment and I spent the next ten minutes racing around the unit, trying to keep from peeing in my pants. After those ten minutes he couldn’t stand it any longer; he told me it was a joke. I didn’t understand and at first I thought he hated me for playing such a cruel trick. But then I realized that it actually meant that people liked me on the unit, otherwise they wouldn’t have teased me like that.
  5. My many friends on the unit– Seeing death every day bonds people together, and I think this is seen acutely with nurses. I cannot tell you how many of my friends, three specifically, treated me more like a sister than a coworker. We helped each other when one of us was getting overwhelmed. We cried when we lost a patient.  We took snack breaks together. We vented about whoever was on our nerves that day. We switched shifts when someone needed it. We sacrificed ourselves for each other, not out of duty, but out of love. And those memories never disappear.

This is nothing to say of the many physicians, chaplains, managers, patient care assistants, and others who will live on forever in my mind. A few physicians that I would like to never see again (and a few that I loved!), a chaplain who I still miss seeing her shining face, a manager who truly always had my back. I remember the stories because of the people in them. I wonder if I am burned into anyone’s memory, if I live on in their story.

I have no idea whether anyone in my family after me will go into the medical profession. My two year old daughter has a Doc McStuffins bag and carries it around giving “check ups” so I’m hopeful for her. But regardless of whether I hand her my nursing pin one day or not, I hope that she will know that her mother loved her and loved other people and was brave and kind and smart and often made mistakes but always asked for forgiveness. I hope my coworkers remember me in the same ways but in the vein of honesty, maybe I’m even tattooed in someone’s brain for something negative, although I hope not. Nobody is perfect. Legacy is inherently built inside of a family, including a hospital one, and I believe there is value in pursuing a memory that leaves a mark.

A woman wearing white shoes passing out pills to psych patients probably never though she would end up being the subject of a blog post one day. I would venture to say the same thing about us. We simply cannot understand the ramifications of our actions and how they may alter the future. Life is ironic like that. We remember faces long after we forget the names.

We remember the stories, long after the people have faded.

 

 

The Bottom of the Ladder

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Nobody likes standing at the bottom of the ladder, gazing up at everyone above and knowing there’s nothing but time, labor and learning that will get you any closer to the top.

It’s a well-established phenomenon that nurses have a hard time transitioning from expert nurse to novice nurse practitioner. This makes sense- you’ve gotten really good at your job, knowing what every medication does, what those labs mean, what the physician is going to order next- and now you’re back at the starting line, feeling more insecure than ever, hating the fact that you don’t have all the answers anymore. If you stayed in your area of nursing experience, I can imagine that this transition is less jarring since you’re already accustomed to your future role but I think regardless of where you came from, the rules are different as a NP. And this can make for some serious anxiety.

If you’re entering into a new clinical environment like me then this transition may leave you feeling breathless, alone and scrambling to catch up. I spent my first six years as a nurse in a surgical ICU learning how to titrate vasopressors and check for compartment syndrome and draw ABGs. I will be thankful every day of my nursing life for the experience of learning to handle such acute patients in a tenuous environment because it gave me an extensive knowledge base about both medicine and people. Over a period of a few years, I rose through the ranks, climbing up the rungs, and finally found myself near the top, confident that I could handle any trauma patient that rolled in the door. But  since I had always wanted to pursue a career as a NP, I felt it was the right time to move on and grow in my capabilities as a nurse.

So after years of hospital life now I’ve entered into the world of clinicals in a family practice outpatient clinic. On the first day I asked, “where’s the crash cart?” and everyone looked at me like I was crazy. Eventually I found the AED and that was it. They didn’t even have an IV start kit! Every bone in my body was rebelling, thinking what in the world would we do if someone codes? Call 9-1-1 and start CPR like everyone else, I suppose. The outpatient setting is vastly different and at first I wondered whether I would enjoy the slower pace or whether I would be sitting at my desk the first day of clinical thinking, oh my gosh, have I just wasted the past two years of my life? But thankfully, I have adjusted more easily than I even thought possible, finding the challenges of a clinic different but not less than, still experiencing the thrill of seeing patients except these patients can actually talk to me.

With two clinical semesters to go, I am still at the bottom of the ladder, dreaming about the breeze of graduation on my face and yearning for the freedom of practicing on my own in the high, clear air. After doing online classes for the past two years, I found that I had in fact learned a few things but I still came home everyday with more questions than answers. I spent my hours at home looking up articles, listening to podcasts, trying to be better. Fortunately, I had a preceptor who allowed me to ask dumb questions and look up answers and Google pictures of skin rashes. He made no ultimatums; he didn’t shame me in my ignorance and for that I will forever be grateful. Plus, I quickly realized that even after years of practice, you never stop learning. You never stop reading articles. You never stop changing your care plan based on the newest evidence. In short, I will be a learner for the rest of my career.

I had so many instances this semester where I felt out of my league. Patients who came in and hadn’t seen a health care provider in forty years. Patients with hemoglobin A1C levels so high the point of care machine couldn’t even calculate it. Patients with feet so disgusting that I literally didn’t know if I should send him to an emergency podiatrist (do they have those?) Patients who told me they had thought of committing suicide. Patients that were medical minefields with a list of diagnoses several pages long and too complicated for me to navigate without some help. Patients who asked me point blank what I should prescribe, in front of my preceptor, and I had to admit that I didn’t know. I was out of my league and that’s just part of adjusting to a new role, of being a student.

Even with my preceptor as a safety net, I still feel the weight of the job like a heaviness in my chest, the responsibility crushing at times. There is a holy reverence when you’re taking care of another human being because they’re putting their trust in you. They look you straight in the eye and believe what you tell them. They listen and consider and take the medication you prescribed. So even though I long for a day when I feel comfortable in my new position as a NP, I can’t too easily wish the anxiety away because it’s going to keep me from getting too comfortable and making a mistake. Hopefully, eventually, anxiety and reverence fuse, leaving me a great nurse practitioner with a holy level of fear.

Am I nervous every day that I show up to clinical? Of course. Will I carry that anxiety with me as I graduate, get a job, and start practicing? I’m sure of it. It’s like when I started in the ICU as a RN and someone told me it would be about a year before I was able to come to work and not be terrified that I was going to kill someone. And they were right; it took me a year to feel comfortable there. It’s like that. From what I’ve heard and read, there are some factors that help lessen this anxiety but nothing replaces years of experience.

So here I am, at the bottom and climbing my way back up. It’s a different ladder of course, one with no weekends and holidays and better pay and different responsibilities. It’s comforting to know that I’m not alone; that every nurse practitioner student in the world probably feels the exact same way- excited, nervous, and a little bit terrified at times. There is hardship in this transition but there is payoff too, mostly in the faces of the people I help or the exultation of knowing I made the right call. There will be falls along the way, missteps. Scraped knees and elbows as I try to hang onto the rungs.

But despite all the challenges, despite those days when I wonder if I can do this, I’m confident I’m headed the right direction. I can see the top from here, and it will be worth it.

 

A Collector of Stories, a Reader of People.

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Everyone who sits in the chair or lies on the bed is there to tell a story.

Some stories start with a misadventure- a careless turn taken on an abandoned road or a flailing, drunken mouth at a local bar or a pop that came out of nowhere, annoyingly enough, and is now here to stay. Some are more memorable than others- breaking a bottle of Tequila on your foot for reasons that no one can quite figure out- and some are less romantic like a contagious illness acquired from a sick kid or a bland case of persistent indigestion. Despite the circumstances, the patient still ends up in the office, led to your chair by an element of surprise. Very few people come to the doctor’s office willingly, on a good day. Usually there are wrinkles in the story. Something has to change the direction of the plot and that is the reason for same-day appointments, plain and simple.

Other stories are more despondent, predictable, birthed from the same relentless situation of getting old. Cartilage does not rejuvenate itself; knees do not grow on trees (as much as the orthopedist might want you to believe otherwise) and people are not getting any younger. No, they are not, they are definitely not. No one can cure inevitable decay, just delay it as long as your insurance will allow, and many stories are repetitions. Slight deviations from the usual, symptom-riddled routine. Tentatively turning the page of a book that may snap shut any moment.

Regardless of the reason for the visit, there is always more to be discovered in the story. Always more details and more complications and other diseases waiting to emerge on a routine set of labs. There’s always more because people are vast and endless, full of the unexpected. People are the most complicated subjects in the world and I get the pleasure of trying to decipher them. To learn to read them.

There is always more to the story.

So what is my job? To find out the particulars of the story. How do I do this? By asking questions. By gaining facts, collecting them in my mind like a child gathering polished stones. At first glance it seems formulaic and in many ways, it is. These formulas are exactly what is taught to all the students who have degrees that enable them to ask such questions. What brings you in today? When did that start? How long has that been going on? Occasionally, you’re allowed to ask a question like How do you feel? but even that is too esoteric for everyday use, a special indulgence reserved for an open afternoon on a boring day. Most of the time it’s a fact-finding mission. Does it hurt a little or a lot? Is it acute or chronic? Can you walk on it? Has this ever happened before? The questions are the title page, the introduction, the scattered highlighted portions that catch your attention as you skim through the chapters. These are the facts.

Some people only tell the bare minimum while others, let’s be honest, tell far too much. Sometimes you’ve already done a full assessment, ordered all the appropriate labs and medications, written the discharge summary and the patient is still telling you unnecessary details, much to your chagrin. That’s where practice comes in- being able to to navigate to the right details, ask the right questions, make people feel like their story has been heard, and still get them out then door feeling satisfied with the plan. You become a narrator, guiding them towards a path you think is the best course of action or leading them away from a more deleterious one, from those singed, cigarette-smelling pages at the end. Sometimes your efforts work and everyone leaves happy and on time. Sometimes you spend the rest of the afternoon frantically trying to catch up. And in almost every circumstance, the extra time is worth it because certain people need a little extra listening, to know that their story is weighty and unique and significant. They need to know that their story matters, even to you.

The real down-in-the-dirt interesting part comes when people won’t tell you some vital detail of the story, something that you know may change the crux of the plot and the direction of your diagnosis. These questions are trickier and consist of types like: How many beers do you drink per night? Would you like to be tested for sexually transmitted infections? Have you ever thought of harming yourself? I try to be an unobtrusive as possible by explaining that I ask everyone these questions and I don’t judge; I just need to know the truth. It’s even more fascinating to watch someone unweave a tale they just told you, realizing that they’ve gotten themselves in too deep. The wiggling in the chair, the lame excuses, the backtracking that has no end. Don’t get me wrong- I’m not trying to catch anyone in a lie- but those things have a way of rising to the surface when the patient is lying naked with a hospital gown on, even without my questioning. A nakedness of the soul, if you want to think of it that way.

Some people think they’re lying successfully but it’s almost always painfully obvious that you drink more than one beer a night or that you haven’t been checking your blood sugars, especially because I’ve become accustomed to patients lying to me from years of being in healthcare. (And even if I miss the deception, labs are always unsympathetically honest). People will try almost anything to get away from shame and sometimes you have to leave the visit in the discomfort that there are pages that the patient simply will not allow you to see and you must do your best despite that reality. It’s unfortunate but I cannot force my way into a story that I’m not invited to read.

It’s even more invigorating to watch someone divulge those details to you willing after you’ve established some trust. They recognize that you have to see all the pages, like an editor who must know every upcoming plot twist, and that they will ultimately suffer if they hide sections from you. They tell you their story; they let you in. They admit things that even their spouse doesn’t know, emotions that they’ve locked away, memories that made them who they are today. It’s a humbling experience, reverent almost, and you don’t forget those visits easily. Those are the lines that you memorize and hold close to your heart, the pages you reread on the days when you wonder if you’ve gotten into the right profession.

And then it doesn’t just stay their story- you enter in. You become a character and establish yourself in a scene, as a life-altering influence who informs them of a cancer diagnosis or a reoccurring character who resurfaces every so often to fix a smudge or wipe some tears and then recedes into the background until needed further. My story blends with theirs, just for a twenty minute appointment, and suddenly we have shared memories, communal pages. That is the true magic of medicine, the part that I fell in love with a long time ago. It’s the part that keeps it all so darn interesting and keeps me wanting to go back and read more. I am a collector of stories. I am a reader of people.

People never get tired of telling their stories and I hope I never get tired of hearing them, of turning pages that always end up surprising me. I am in love with the narratives of the people who wander in to see me. I am infatuated with being a part of a bigger story than my own. I am a nurse practitioner (or at least well on my way to being there) and a storyteller at heart.

And, strangely enough, I have figured out that those are really the same thing.

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.

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

 

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Hypochondria of Advanced Medical Education (HAME) is a spectrum disorder ranging from acute to chronic that occurs when a person overreacts about his or her own medical problems due to an overload of knowledge about disease and dysfunction. This leads to distortion of reality and the inability to rationally process. Risk factors include being a healthcare professional, being a student in a healthcare field, having a type A personality, stress, and having comorbid medical conditions. This disorder can also 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. This condition is the result of the constant inundation of comprehensive information regarding every disease known to man.

In this disorder, the student does not use rational clinical judgment and decision-making skills in diagnosing his or her own symptoms. Instead he or she 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. For family members, this turns into sheer panic and an in-depth study of all possible ailments starting with the most life-threatening. The disease ranges from mild to moderate to severe, which is classified as the insomnia-producing, worst-case-scenario-imagining, assumed-to-be-life-threatening form.

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.