She Lives!

Nowadays, it is rare when I find myself wide awake in the early hours of the morning. Late night midnight or early two am runs have not occurred in over a year now.After tossing and turning, I decided to get up and do something productive since I could not sleep. And what better way to beat insomnia than write a blog post? Yes, I do realize it has been for-e-ver since I have written.

Mother nature has been acting rather odd as of late.  From digit-freezing weather to giving us a glimpse of springtime, only to take that glimmer of reminiscing how amazing spring is away from us. I did go out on a couple road rides bundled up as a riding ninja, but not as much as I have been riding in the past due to the fact I lost one of my beloved lobster gloves. Bad circulation + riding in freezing temperatures = me unable to use my hands for a couple hours post-ride until they thaw…Which is an incredibly painful process. Spring, please come soon.

I was able to, however, capture a couple awesome shots of the frozen land.

IMG_2146

Trail run

Trail run

IMG_2149

Frozen ride

…So was Kevin on weekend days when I had to work.

A little too close to the ridge for my comfort.

A little too close to the ridge for my comfort.

Due to the lost glove, I’ve been spending more time on the trainer (ugh), and Kevin actually purchased rollers so he could ride indoors.* Note: He once told me that he would never ride indoors. I’m pretty sure he was jealous of my indoor riding and wanted in on the fun. I even captured a moment of him trying out my set-up before he realized what he was missing.

Caught!

Caught!

In between working way too much ( it IS possible for this girl to turn into a workaholic), my baking adventures continue, as evidenced by the photo below. If colleagues decide I should quit nursing and bake all the time, I guess the baked goods are noteworthy.  That, or I’m just a lousy nurse–I prefer to think the former.

Chocolate chip cookie dough cupcakes

Chocolate chip cookie dough cupcakes

Since I do not like cupcakes/cake, Kevin has been an eager guinea pig to test my creations before they head to work. In the meantime, I’ve become a fan of making smoothies (which is a post in itself) in an attempt to consume healthy things. Below is one with almond milk, peanut butter, banana, blueberries, chia seeds, and ground flax seeds. Vegan/vegetarian friendly and ohh-so-delicious, especially post workout.* I’m looking for protein powders to perhaps add, if anyone has suggestions of a good type/brand?

Mmmmm

Mmmmm

On the subject of nursing, nursing outside of the workplace has actually come in handy numerous times. For example, having your bag with scissors and tape allows for improptu Valentines Day gift wrapping in your car. I can also just lounge in–clean– scrub bottoms when I am too lazy to even put on sweat pants on a day off. Now that, there, is just plain LAZY lazy.

Well, I suppose I should try to get some zzz’s in before Kevin and I head to Europe later today. Yup, going back to my homeland! When I return, photos from the trip will be shared, and training for races will resume.

Happy February everyone!

Post script: Since writing this, I found my second Lobster glove!

 

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Twenty Six Check Marks in Black Boxes

I’m somewhat of a geek when it comes to lists of things I need to do. Whether it be around the house, or things that must be accomplished at work. And there is no better feeling than either crossing the task off, or checking the little boxes I placed adjacent to each idem needing to be done.

Unfortunately, I do not have the computer skills to add little boxes to my list of things I would like to accomplish before I am twenty-seven nor have the ability to check them off, so, black slash marks will have to do if I, or when I finish that mini task (or goals). I started this list after by 26th birthday– taking the idea from a friend of mine, Bekka, who has her own blog and, might I add, has the most adorable daughter ever! I have a link to her blog on the right of the screen if you would like to read a fantastic blog. Then I  thought I should finish it, even though it has been a couple of months since I turned 26. So, before you, I have twenty-six items, each of which I hope to do or attempt, before I turn (gasp!) 27.

1. Finish an olympic distance duathlon

2. Finish Timberman  stupid Lyme Disease.

2. Feel comfortable in a new type of nursing job–one which I’ve never done before.

3. Apply for graduate school.

4.Try a new recipe every month. Specifically, make homemade pasta, without a pasta machine….It is possible.

6. Create more complicated cake pops and cakes** I have done some here .

7. Ride the whole of the Tour de Catskills course. Not at the same time as the riders though. If I did that, I’d be dropped like a donkey taking drugs. (I have no idea where that thought just came from). 

co. of tour de Catskills

9. Take a random, spontaneous, weekend trip with no plan or destination in mind.

10. Cycle through NY, MA, and CT then back to NY. In one day.   (It is possible)

11. Find one new book to read (non medical related)—-every month—-have any suggestions? (I borrowed this idea from Bekka.)

13.  Go camping in the Adirondacks, bringing only the bare necessities, and bikes.

14. Travel to Europe.

15.  Crochet an afghan.

16. Run another half marathon. Or 5k.

18. Go on a group road ride. I’ve gone on several mountain bike group rides; basically the same thing except the type of bike being ridden.

19. Learn medical Spanish.

20. Learn how to meditate.

21. Run before work ( tough when you are on your feet for 13 hours a day).

22. Race two NYCROSS races.

23. Hike up Mt. Washington

24. Hide the scale and only use it in Doctor’s Offices.

25. Move out on my own.

26. Complete a course in Complementary and Alternative medicine and therapies.

It’s Been Way Too Long

It had come to my attention this morning at 0334 after completing my top-to-bottom, rip-the-house-apart cleaning spree that it’s been way to long since I’ve written in this. To be honest, I came to this realization earlier in the evening when noticing all the changes that had taken place on the wordpress site, along with the facebook site (what are those changes about?) and even pandora has changed! Actually, to be even more honest, I’ve simply nothing to write, which came up in a conversation I had with a friend the other day.

“You have nothing to write about? But, don’t you usually write what comes to your mind anyway?”

Which I interpreted as,

“Molly, your posts are utterly useless paragraphs composed of mere, insignificant ramblings, so what,  suddenly you have no thoughts anymore?”

Well, life has been somewhat busy in the past month. I’ve been working more overtime than usual, which has left me depleted of energy (either that, or the lack of sleep, or lack of sunlight due to working night shifts) and I haven’t been out on too many long rides or runs as of late. I feel working the night shift just zaps you of energy, atleast it does for me.  I think I am still going through my quarter life crisis, which I think has been going on for about a year now haha. I’ve been contemplating, and applying, for different jobs. Working at TKH is just chaotic at some points. And the more I work there, the more I see things which disturb me enough not to want to work there anymore. And, why live a life, and work at a job when after you leave after that 12hr night shift, you cannot help but feel horrible about yourself as a nurse. I’m not sure about you, but I prefer to feel good about myself. My knowledge of ICU nursing is ever increasing, and there is still a ton that I don’t know. But, I think it is time for change.

And that change might be change of location, change in job, change of….lots of things. I’m not one who needs a lot in life to be happy– if I have my bikes, the ability to ride, run, swim, hike, then I’m all set. Ohh, and a comfy bed, too.

So, bring on applications to hospitals all over.

Part 2…….Wait, two parts in one post? Yes!

Since starting this post, I actually went for a 30miler in the afternoon, and then went for a run around 0330, which felt awesome. Especially the ride. Biking always puts me in a great mood.

I was slightly bummed the other day because I missed the last duathlon of the season–I was smart and decided my body needed rest after working three night shifts in a row and then working an extra 4 hours after my last shift (16 hours really leaves you drained).

view from my ride

I cannot believe it is already fall. I love fall. The crisp, autumn air. Brisk mornings…Hopefully these incredibly annoying mosquitos will leave soon.

Next week, since I have five days off yesssss! I plan on going back north to do some mountain biking and hiking. I cannot wait to go. Someone asked me if I always travel alone. And to think about it, I do most of my traveling alone. Yes, sometimes it gets lonely. And yes, it would be nice to have someone to go on hikes with and mountain bike rides with (I have the best road trip  music ever!). But I’ve done so much traveling alone in the past, that I am kind of used to it. And, a good thing about traveling alone, is you can go by your schedule–all you have to think about is yourself, and not have to worry about anyone else. Therefore, if you want to wake up and leave a destination at 0330 in the morning, you can!

On a different note, I’ve been considering CX racing, which means, I need a cross bike. And, despite my adoration of Scotts, they do not really have cross bikes. So, I was thinking about Giants TCXW.

The colors match my mountain bike!

Yes. The over time I’ve spent at work has definitely made it possible for me to go down to Billy at Overlook Mountain Bikes to get a pretty friend for my other bikes. And, perhaps to start CX racing this fall.

What Happens A Year Later

Life has a funny way of slipping away from you before your eyes and without you even realizing it. Perhaps for those who have 9-5 jobs and have a certain “rhythm” to life, or routine I should say, time might seem like it’s not going anywhere. With the craziness and furthest from “routine” of a life I have, time seems to fly. I’ve noticed I have no real concept of what time it is, or which day it is–excluding days I work and the time it is while I’m at work. I, like many other people in my profession, have the tendancy to get into work and ask, “Hold on, what’s the date today? And it’s Monday?”

Most of the time, the response is, “I think it’s Monday. You don’t know the date?”

And my (our) response is, “Hun, all I know is I’m supposed to be working tonight.”

Time seems to slip away from you

Your days mesh into one big blob of days (yes, my vocabulary is quite extensive, isn’t it?), weeks into months, and before you know it, it’s the middle of June. Working nights and running on a continuous empty tank does not help. My running on empty first alarmed me last Friday night when I showed upto work and my confused coworkers looked at me saying, “What are you doing here?”

“I’m working.”

“Mol, you’re not on the schedule.”

“Ohh, that sucks. Okay. I’m going. Bye!”

Don’t worry, it’s happened to other people…I think.

Monday, after working two nights in a row, I slept on-off throughout the day. I think the running on empty finally got to me, and the fact work has been insane. It seems I’ve been the one receiving insane assignments and have been the “code/rapid response person” more often than I’ve wanted. (That means, you go to all the code blues and rapid responses throughout the hospital.) Just a FYI, an ICU nurse needs to go to each code, because they are ACLS certified, so they are the only ones allowed to push the medications in a code situation. And, the last few times I’ve been “code/ rapid response person, nights at work have been nuts. I had a code and we coded  a patient– shocked her, gave epi, etc etc, and by the time I brought her to the ICU, she was PEA. Less than ten minutes later, a rapid response was called and the patient I brought up was fine. But, I brought him up at 0630, and still had to do things for the two other patients I had–excluding getting my PEA lady ready for the family to come in and see her. (Another FYI, PEA is pulseless electrical activity, meaning the heart is not actually working, but there is electrical activity that shows up on the monitor).

Insane.

As many are aware, I’m somewhat quiet. And people at work have picked up on that little fact (well, they should after me working there a year). But my inner ICU nurse voice, and frustration at the stupidity of some other nurses, actually made me raise my voice at someone during the code. I did not yell. But I swore, which I never do, except for when riding or running.

The doctor ordered Amiodarone.

“Can someone draw me some Amiodarone?” I was almost yelling. I felt someone put in a syringe and a small vial into my hand. I looked at it.

“This is f-ing Narcan. Is this lady detoxing? No! Give me the Amiodarone. The f-ing brown vial. No. no. Move, let me see.” I pushed the nurse out of the way and looked for the Amiodarone.

Okay, I felt bad, because I think I scared the other nurse. But he was giving me the wrong medications. And, I sounded mean, which I’m really not. It was just an emergent situation. And, I found my inner ICU voice.

When I went back to the floor and told the other nurses, they laughed and said, “Awww, our little Molly is a true ICU nurse when she swears and pushes people away in codes!”

I started this job a year ago in June….Around this time actually. And the things I know now compared to when I first started amazes me. The drips, the diagnoses, the treatments…My knowledge of medicine and nursing has expanded tremendously. I’m not sure it’s what I want to do forever, but it certainly has opened up my opportunities for the future.

 

What I Love and Hate About my Profession

In attempts to further delay the ride I have planned for today after just seeing that it is eleven degrees outside, and “feels like -1,” I thought I’d write a post about nursing–one of the original reasons for starting this blog (crazy, right? You thought I started the blog to follow only my training).

It’s been almost nine months since I started working at TKH, and the past couple nights at work were bearable. I have no idea how people work five days in a row–a week. Last night I finished my fourth shift in a row, and towards the end of the shift, when you are getting ready to go and give report, your brain just ceases to function. As my colleagues pointed out, I tend to laugh a lot when I am exhausted. Laugh at insignificant things, too, so much that I start tearing up.

Working in an adult intensive care unit is a completely different type of nursing than pediatrics nursing, and I miss working with kids. Yes, there were times working in the PICU where your patients passed away, which was heart wrenching, because they were two years old and in my mind, children should not die. But, on a normal med-surg pediatrics floor, sick children are still children, and there are a lot of nurses who could never work with children, simply because they are kids and not adults. They walk to the playroom lugging an IV pole behind them in one tiny fist, and holding a parents hand in the other. They squirm and wiggle around when you try to listen to breath sounds, and get tangled up in tubing in their crib. Some kids grow up in hospitals, with rare medical conditions that make the top neurologists ask questions. They attempt to color pictures for you, and ask to play games.I miss feeding the infants at night, rocking them to sleep. Yes, something wrong happened and they had to get hospitalized. But, the majority of peds patients get better, and can go home, and continue to be…Kids.

Adults are different. Actually, in some ways, it’s harder working with adults than squirming kids. Adults are needy. They may not complain about not being able to play and have to go to sleep, but they complain. I’m pretty tolerant of needy adults, but after five hours of constant bell ringing of needing another sip of water (when I put two pitchers of water next to your bed) or that the sheet is not covering your toes enough, I get a little fed up.

Life is funny. You enter the world needing to be nurtured and taken care of, and in a lot of cases, leave the world, much older, but needing the same basic things.

Why am I thinking about this? I just had a nineteen year old boy who was in a MVA in October–before then, completely normal. A walking, talking, athletic, teenager who was ready to go to college. I have not taken care of a 19 year old since living in D.C. Now, his pupils are non reactive, different sizes, and fixed in place. He has a PEG tube. Seizures. A tracheostomy. He couldn’t keep his heart rate up on his own–we coded him, twice.

And when the majority of the patients you take care of are sedated and on ventilators and have breathing tubes to help them breath, when you actually get a (friendly) patient to talk with, it’s special. And, that’s a reason I became a nurse, to care and nurture, to listen. To be a presence and help someone during their most vulnerable times. And nursing now a days is not like that.But I had a rare night last night when I could do that. My patient had gone into flash pulmonary edema on the floor and was rapid responsed needing to come up to the ICU. I was the ICU nurse who went to the rapid response, and he ended up being my patient in the ICU. It was amazing how well he did after given the NTG drip, lasix, morphine and beta blockers, as well as Bipap.

The next night when I came back to see he was my patient again, I walked into his doorway and exclaimed, “Well, look at you! Sitting up in bed eating some crackers!”

“I know, hun. Do you have ice cream? I really would like some ice cream?” He said as he scratched his face.

This 78 year old man was cute as a button.

“Sure, let me go find some!”

And then, after his snack, I gave him a bath while we talked about the hospital. And he asked if I could shave him (he had long side burns and a mustache/almost goatee ) and I said, “Ofcourse!” and then I went on to lather up his neck, cheeks, and chin, and shave him. (Might I add, I did a wicked good job shaving that goatee he had). After it was all done, and I was wiping away with a damp washcloth the excess shaving cream from his face, he looked up at me and said, “you know, I never let anyone else shave me, but you seemed special.”

“Well, Mr. X, I hate to brag, but I did do a fantastic job, and you are handsome as ever now.”

That last story was one reason why I love my job. The human to human contact you have with your awake –sane–patients. The stories that make your heart sing.

Another reason I love my job: I love my coworkers to death. They are amazing women and men, with a wealth of knowledge that I can only pray one day I will have. They care about each other. We laugh when we shouldn’t be laughing, occasionally cry when we shouldn’t be crying. We’ve become family. With my parents living overseas, I’ve found my “America Mommy and Daddy” at work (corny, yes.)

I love  when you have the rare, incredible turn of events on a patients stay. They coded three times, could not seem to be weaned off the ventilator, and are in the ICU for weeks. Then after a week of being away from work, you come back and ask, “Where is Ms. X?” And your colleagues say she was discharged from the hospital the day before–walking and talking. Then you get a card with a picture of the patient holding her lap dog again. It’s joyous.

I love some of the comments that come out of patient’s mouths sometimes. They are simply hysterical. For example, the 78 year old man who kept asking for a diet coke, and wanted the hot blond nurse back the next day….Man, I have a million hilarious comments.

I love the action that happens in the ICU–the controlled chaos. I’m a closet adrenalin junky.

What do I dislike?

Residents who do not know what the hell they are talking about, giving you orders and telling you to do things that you know will kill the patient. In the midst of a patient going downhill, the resident on the phone with the true doctor, unsure of what is happening. You feel like slapping the resident and pulling the phone from his/her hand and talking to the doctor yourself. I’m not saying all residents are like this, but some are. Just because you have been to medical school doesn’t mean you need to be a cocky nasty person.

It disturbs me when after years of ignoring a family member as evidenced by the lack of hygiene and medical state they are in-once the family member is admitted to the hospital, the family members are all of a sudden involved in the persons life. How could someone ignore their sick mother for years, and all of a sudden care?

I don’t like yelling. I don’t like screaming. I try to avoid conflict, and am incredibly passive (yes, passive aggressive too). Probably one of my biggest flaws. I hate having to raise my voice when talking to others. I have a very hard time criticizing others, and even harder time when others criticize me (perfectionist? Hell yeah, I admit it. Being a perfectionist and working in intensive care works well. In order to be on top of everything, knowing each detail is required). I’m getting better with age with the criticism, but still have a thing with people yelling at me. Even though it happens often in a hospital setting, where stress levels triple of family members and friends of the patients, I know because I was there when my grandmother was in the same ICU as I work last year, it still bothers me.“Poor thing, got slammed by a family member last night. Could you imagine? Someone screaming at our Molly?”

And there is nothing worse than getting yelled at for something you have no control over what.so.ever.

“Ma’am, I apologize, but I have no control over that, you really need to discuss that with the doctor tomorrow. I’m not a surgeon. I’m not a doctor. The knowledge I have about your husband is what I’ve seen documented, and the report I’ve gotten from the other nurses.”

The above example is another thing I dislike about the job.

Another one: the insane amount of paperwork we have to do. I care. A lot. Too much. But you need that in my profession.However, a warning to new nurses. Nursing now is not what it was twenty years ago. If you do not like to document, don’t become a nurse. At least in the United States of America. I would say, 90% of nursing now is covering your ass for what you did and didn’t do. Not to scare you, but just think– in a country where you will sue your neighbor for falling on their driveway over a branch, imagine now working in a profession where you are legally responsible for caring for a living beings life. If you write in a note that you gave a medication or you called a doctor, you did that. You wrote that down on a medical record. Twenty years from now when you are in court and people are asking you what happened on that “Tuesday at 0215 on so-and-so date” will you remember? No. But the documentation will. There is a reason in nursing school now they drill “DOCUMENT.DOCUMENT.DOCUMENT.” into your brain. What do I remember about nursing school? Those three words. Well, those, and just pure misery.

I don’t like the fact that in the adult ICU, the majority of the patients will never leave the hospital due to their age and medical condition. Unlike kids, they won’t bounce back to perfect health.

Lastly (I could go on and on with this post), it breaks my heart to see grown men cry. I can deal with women crying–it’s what women do. But when a son comes to visit his dying father in tears, I think I can actually feel my heart cracking. And I’ve dealt with a lot of deaths at work.

All in all, I still feel I could not have picked a job that fits my personality better. I know I won’t be staying at TKH forever, but thus far, it’s been a great job.

I’m Not Allowed to What?

There comes a time in every athlete’s life–hell, in everybody’s life–where they get injured. And no matter what the injury, there is usually some annoyance associated with it. The injury may be a paper cut. Small little slice, but you are always aware it’s on the top of the finger because there is a slight burning sensation whenever you wash your hands. Forget attempting to clean tools in any type of paint thinner or putting your hands in corrosive liquids–not that you might attempt such a task. (I have no idea where the cleaning of tools came from, either. I don’t clean power tools.) The injury might be a broken arm, or torn ACL. Most injuries though, happen as accidents. And, boy, can they really mess up your planned schedule.

I’m someone who plans. I enjoy spontaneity–it brings excitement to life–but I also feel more comfortable being able to look at a week and know what will (or should) happen everyday. I’m someone of a nut and have this fascination (that’s a more sane word for obsession) with calendars. I think I have four for 2011. All calendars have very similar tasks/ events marked in the boxes. Next to the events are smaller boxes, where I can tick off that I finished the task/event (you really need to read my friend’s blog–she shares some of my compulsive attributes–it’s like reading my own thoughts). My need for structure and somewhat overly detailed daily lists could be a post of their own.

I do not like when my schedule is disrupted and changes are made. Although, I am much better at dealing with changes now. I’ve learned to be adaptable to most situations and not freak out when something different happens. I guess that’s what happens when you work in a controlled chaotic work environment and things are constantly changing. And, as long as I am the one doing the modifications to my schedule, everything is a-okay.

This past week’s schedule, on the other hand, was modified by external factors, which I don’t like. On that note, the rest of the month’s schedule has had some changes made to it as well due to an accident. No, I was not biking, running, or swimming when this happened either. I was shoveling my stairs. S-h-o-v-e-l-i-n-g.  The act of moving snow from one place to another to get it out of your way. Due to the act of shoveling, I had an insult to my head causing some mild degree of loss of consciousness. In lay person terms, it means I slipped on the f-ing ice, hit my head against the stairs, and passed out.

Might I add, this happened the day after my scheduled yearly physical (which I strongly suggest everyone have–most insurances cover a free physical a year–definitely take advantage of that) where my doctor, who might be one of the rare physicians I can tolerate and admire, told me I was in fantastic shape, and wished his other patients could be more like me (come on, who does not want to be me?!?).

Less than twenty-four hours later, I had my non-scheduled visit to Northern Dutchess’ Emergency Department, all because of a little knock to the head.

This story does have a point, and I am getting to it slowly but surely.

I’m not a fan of hospitals. Scratch that. I’m not a fan of being a patient in a hospital. Furthermore, I’m not a fan of people telling me what I am and am not allowed to do. Don’t get me wrong, I prefer having people tell me what to do in work/ follow directions. But not when people tell me what to do with my life.

After hours in a painful neck brace (as the medical professionals were unsure of if I did any damage to my cervical spine when I fell, and I have no recollection of the first couple minutes after I hit my head), CT scans, an MRI, unexperienced nurses trying to start multiple IV’s (I prefer to keep my blood to myself, so make it hard for nurses/phlebolomists to access it…In the healthcare  field, I’m known as a “hard stick”), I found myself waiting anxiously behind a closed curtain in a cold emergency room, staring at the normal saline running into my AC. There was some disbelief in the fact that I was (1) it took three different nurses to start the IV after five attempts, even when I kept telling them to just go for my left arm because that’s where the veins are (they didn’t listen), (2) I was spending a day off work in a hospital and (3) that I had an injury while not training.

Finally, the ohsoverykind ED doctor decided to return and say hello and let me out of the incredibly uncomfortable C/S collar. Have I mentioned I worked in an ER and know what happens “behind the scenes,” making me somewhat impatient as a patient?

“Well, Molly. Good and bad news.Good news, scans are negative. No bleeding. Just a bump on the side of your head. With any head injury, it’s always more concerning when there is loss of some memory around the event, loss of consciousness, and vomiting–all which you had.”

I knew what news was coming before he continued to speak.

“Bad news is, you said you are training for a couple big races.”

“Yes.”

“That would explain why you have a resting heart rate of 52, which is good. Means your heart is in great shape.” Somehow I think he was veering off topic. This non-scheduled visit was because of my head, not my resting heart rate. I was annoyed.

“My medical advice is that you abstain from any physical activity for a while. We don’t know the extent of the damage, but after I what i just said, you did have some sort of brain injury, even if there was no evidence on the scans. Which means, no swimming, no biking. No running.”

“You’re telling me I’m not allowed to do those things? For how long?”

“I cannot stop you from doing what you do, but my advice is just to take it easy for a couple of weeks. You are a nurse, what would you tell your patients to do?”

Sigh, I hate when people say that, because I’m great at giving great advice that I never do myself. “You know, this really messes up my schedule.”

“I’m sorry.”

You get the point. He continued for another couple of minutes with discharge instructions and then finally stopped talking.

So, for four days, I’ve refrained from any physical activity, besides work. And, it’s driving me mad.

If you are an athlete who has been injured, you know how painful it is not to be able to do something you love. I’m antsy to get out and go for a run in this beautiful weather. Yes, I know it is freezing out. My bike misses me, I know it. I’m beginning to miss the taste of chlorinated water.

Long long story short (well, somewhat short), all will be well. But my training schedule must be modified. And  we’ll just have to see if I’ll be able to tolerate this lack of activity for much longer. Come visit my house, and you’ll notice it’s unusually clean, that all my clothes are now color coordinated (I noticed the majority of my jackets are orange, a blinding reflective color, or green–not weird at all), and I’ve baked more food than the inhabitants of Luxembourg could consume.

Okay, who turned the coffee pot off?

I learned turning off the coffee pot at night is a big "No No"

I feel like it’s been awhile since I have written on this blog, when in fact, I think my last post was written yesterday. Even so, I have the opportunity to reflect on night shifts, and life in general (perhaps you’ve noticed, I do a lot of reflecting). If by any chance you are a fellow night shift worker you might be able to understand what I talk about when your days seem to mesh into one big “glob” of days when you work night shifts, at least that is what it feels like to me. You become incredibly disoriented to the time of day-day of the week and month of the year you are in because your internal clock is so screwed up.

It’s been a couple of weeks since I started working nights in the ICU, and working at night is a whole different world than working during the day. I do not mean to offend any of my day-shift colleagues (who have been amazing), but nothing beats the fellow staff members I work with at night. Nurses and staff who work on a unit at night become a family–they reach out to one another before you can ask for help. And, depending on the staff you work with, night shifts can be fun. You make it entertaining in order to survive. There is a lack of support during the night shift–by that I mean fewer people on the floor to help you accomplish tasks–especially fewer patient care technicians (who are the nurses best friend). There are fewer nurses scheduled to work night shifts, even though there is the same number of patients on the floor (I know, it makes no sense). The pharmacy closes at 11pm and does not open until 6am, so you are mixing your own medications for patients if there are none made up.

Your critical thinking skills come into play more on night shifts, since there are no doctors around (yes, they can be contacted for emergencies, don’t get me wrong). The doctors rely on your critical care skills to be their eyes and ears when the are not there. “His blood pressure has been trending down; his MAPs are lower than 60, he’s throwing PVCs everywhere, his urine output is poor–would you like to give a bolus, or start him on some pressors?” If you are working in the ICU as a nurse, you need to be on the ball all-the-time for all your patients. There’s really no room for errors or mistakes, but we are still human and, mistakes and errors do occur. And yes, the number of law suits against nurses is on the rise in the United States, sad, but true.

For the first time in my nursing career, I now have malpractice insurance. On that note, that’s why documentation is drilled into your head from the beginning of nursing school. If you did not document that you did something–an intervention or give a medication–then you didn’t do it (even if, in reality, you did). During hospital orientation, the Hospitals legal representative came in to speak with the nurses just about documentation (kind of like a “freak-you-out” session of what happen in the United States with all the malpractice suits). Yes, in school we learned about documentation. But I never knew I’d end up needing to get my own malpractice insurance one day.

Back to night shifts. Nurse deals with more paperwork at night, more chart checking, wash and bath the patients, on top of the “normal” nursing activities that must be done for patients–medications, weaning from ventilators, dressing changes, etc. If you are a nurse, you know what I mean.

And let me tell you, even though one might assume that the night shift is a “slower” shift than day shifts, since there are fewer people around, fewer medical students to get in your way and asking questions that you knew the answers to when you were in nursing school. But, they can be busy. Very. Busy. For example, the other night, we had two patients discharged to different floors, four admissions from the emergency department, a code in house that had to be brought up to the ICU, and a rapid response that was brought up to the unit–all happening within the span of four hours. Right as I was helping the code get settled in one room I gazed up from the leads I was placing and just so happened to see my admission from the ER being rolled into another room. As you read it, it might not seem as insane as it was. Ofcourse, my admission was in DKA who needed hourly blood glucose testing and sliding of insulin, and all the admissions orders were messed up, so the time I was outside this patients room, I was on the phone with the doctor. Thank goodness my other patient was “stable.” Just crazy. Yet, craziness on night shift is good because it keeps you going. Otherwise, it can get painful trying to stay awake when you are exhausted.

After working three nights in a row, and averaging a solid four hours of sleep a day, I feel like I am living in a daze right now. You know that marathon I was going to do–tomorrow? I was “training” for it. Well, after a good solid week of trying to decide whether to do it or not (I’m incredibly indecisive, and if you were around me at that time, it is the only thing I talked about “Should I, or shouldn’t I?”), a sane friend told me it would probably be a bad idea to run and I’d wreck my already exhausted body. I’m fighting feelings of guilt and sense of disappointment since I am not doing it. But now, I realize it would have been really stupid to do, and there is no way I could have the energy to do it after my crazy nights.Thank God for the people in my life who do have normal views of sports and can talk sense into my stubborn self. (I do wish my friend incredible amounts of luck for running his first ever marathon–Go out there, run quickly, and don’t break a leg!!) I warned him that they are addicting (that’s another one of my many “gifts”– inspiring people to run long distances), and I can’t believe how hardcore of a runner he’s turned into since I’ve known him.Rock on, T.R!

Fall

With this incredibly gorgeous fall weather we are having, it’s painful for me not to be outside. So after a three hour nap, I got up and washed my car (I think it loves me now–it was just a tad dusty), and am about to head out for a bike ride. To satisfy the need of putting my body through pain, since I am not running the marathon tomorrow morning, as well as to help fight the feelings of failure, the insane person within me signed up for a duathlon that is only 30 minutes away from where I live. Replace a marathon with another race. Why not? It’s my day off.

It’ll be a piece of gluten-free cake–if I can get my legs to move that is.

Graveyard shifts and marathons

The time has come for me to start what I was originally hired to work: the dreaded night shifts. I honestly do not mind working night shifts–in the ICU you are kept so busy that you can stay awake. Well, that, and lots of caffeine. Night shifts are tough on your body, because you lack normal sleeping hours, and your days off are spent trying to catch up on sleep.

I’ve found that there are advantages, and disadvantages to night shifts. I think the negatives definitely outweigh the positives. For example, you sleep during the day–when it is light–so unless you want to skimp on sleep (which I do anyway), you will not see much sunlight. Most of the rest of the world is awake when you are sleeping. Doctors offices are closed, and it is sometimes more of a chore to speak with people when you need to when you are working at night. Personally, my nose starts to run like a faucet when I’m tired, which is not good when you are trying to give report to someone and constantly blowing your nose.

Advantages are that your fellow staff work much more closely together (they have to), and you become like family. There are fewer people cluttering the hallways, so you have more room to work. There is pay differential–if there wasn’t, it would be cruel. Weekends are considered Friday and Saturday, instead of Saturday and Sunday. When you leave work and go home, you can think as you pass other cars, “Haha, you have to go to work, and I get to go home and sleep.” Because you sleep less, you are more productive–now since there is a bit of light left before the sun sets at night, I can get in a run before work.

Although thus far, I’m not sure my body has adjusted to the night schedule yet. It’s tired. My muscles feel workouts. A five mile run feels like a fifteen mile run. A thirty mile bike ride feels like fifty.

I keep debating on whether or not to do the marathon in a week–after three shifts in a row, going home saturday morning to take a nap then drive up in the afternoon to run 26.2miles on Sunday morning, and have to drive back that afternoon as Monday I’ll need to return to work. I think any rational human being would think twice about that decision.

Hand Washing Anyone?

Just to warn you, this post is not about training or sports, although it still applies to athletes. It’s about hand hygiene. Whilst driving my friend around the area yesterday, she could not help but point out the number of small containers of hand sanitizer I had sitting between the passenger seat and drivers seat in my car. There must have been a sale at Bath and Body Works for travel sized hand sanitizers, and I got carried away, hence why I have so many in my car.

I cannot help it; the overuse of hand sanitizer was instilled in my brain when I started nursing school. I’ve seen that children in schools have sanitizer attached to their backpacks (it’s a good thing, kids are learning disinfection techniques). And, I admit, when I traveled in areas of Africa where the water is the source of bacteria, alcohol-based hand sanitizers were what I relied on, and were a God-send.

But in this country, the good old U.S. of A., I fear this use of sanitizer is taking over the importance of simple hand washing.

So what’s with this fad of waterless hand sanitizers? What are the benefits of the water-less, germ-busting gel that seems to clear your sinuses when you take a whiff?

One clear benefit is the fact there is no water needed when you use hand sanitizers. I remember when I was younger having alcohol wipes in my lunch box, and the fact they had different scents was an amazing thing. Hospitals now have waterless sanitizing gels outside every patient room (or should), with the hope people going in and out of the rooms will use it. But as much as you wish the Purell will kill every little bug on your hand (why shouldn’t it? It’s advertised to kill 99% of bacteria…even organic, “non-toxic” varieties of hand sanitizers), it still is not as good as using soap and water.

Yes, I am writing a post about handwashing. I hope you learned in pre-school and at home how to properly wash your hands. Yet in orientations to healthcare professions, there are still demonstrations on how to wash your hands correctly. Okay, I am not quite OCD about hand hygiene, but I come close. I think that with the overuse of hand sanitizers people are not washing their hands with soap and water as much as they should. There is still that 1% of bacteria which is not killed by Purell. And one nasty bug that resides in that 1% is Clostridium Difficile–aka C.Diff– a normal bacteria found in your gut but can cause extreme diarrhea if it gets out of hand, and is NOT washed off your hands by sanitizer. C.Diff spores can live on surfaces for up to 5 months, and the true, known way to clean it off is by the old fashioned soap and water. Moisten your hands with warm (not scalding, not freezing) water, squirt some soap into your hands and lather up a storm. It’s not that difficult, and takes less than a minute to do.

Still, I cannot TELL you how many people I come across who clearly have not washed their hands recently. I will never forget the time I spent in an emergency room (i am not naming names, but it was in a developed country) when the doctor completed a procedure involving sutures and open wounds on a family member and he did not wash his hands. The thought still makes me cringe.

Please, I’m asking of you, teach your youth, or friends for that matter, how to wash their hands with water and soap, and not to rely on Purell. Yes, the waterless gels are a good for traveling in third world countries and areas where you will not have a good reliable water source, and I do suggest taking some along if you are unaware of what your availability to water will be. But if you have access to a faucet, use it.

Hand washing, in my mind, is something that will never go out of fashion.

‘Till Death Do Us Part

There’s something about working in Intensive Care that you must face early on while working there: death and dying. It’s a hard subject–it is scary–why else would the “Grim Reaper” look so freaky?– but it’s a part of the natural life cycle. Although, I feel the life cycle should encompass birth, living a somewhat long life, and then dying, it does not always happen that way.

A tricky thing with working in the ICU, is you have patients who you’ll see for months. I saw it while working in the pediatrics ICU, and the same goes for normal med/surg intensive care units: the staff develop relationships with, more so, the families of the patients. You see the family members in the morning, and at night. They call during the day. For months, the nurse will see patients moved from different rooms on the unit, saying while getting report, “Oh, I took care of him/her while she was in Room X.”

And then, the patient expires.

The staff expected it long ago. If modern medicine was not here, even forty years ago, the patient would have passed away months ago. Even though you were expecting it, and waiting for it to happen, you feel a loss. And as staff members, if you cannot build an emotional barrier between yourself and the families you take care of, you simply cannot exist. And the barrier can crumble easily.

My barrier seemed to crumble today.  I’ll build it back up tomorrow.

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