http://www.flickr.com/photos/heidi/sets/72157624568965952/
i posted a journal entry up at flickr

sometimes i just listen

patients often just start talking to me whilst i am doing some nurse procedurey type thing on them/near them, and i usually like listening to them, for various reasons. first of all, it keeps them calm to keep them talking and keeps their mind off what i'm doing to them. second, it's usually entertaining for me. most patients are elderly and they don't have any problem speaking their mind or telling crazy stories - stuff like that. third, i often walk away with a story or a memory they have held that i will remember for a long time.

i miss working with the military sometimes because the VA patients tend to have colorful stories of war times or just their youth in general was interesting. old guys just have cool stories, you know? a lot of my really elderly patients up here where i live now are more of the farmer/pioneer/fisherman/oil-men types who moved up here back in the day when there was just mountains and trees and eskimos and whatnots and they were still speaking dutch and german. not saying stories about tulips and cows aren't interesting, because they are. but it's ain't no south pacific tale.

anywho, excerpt from this AM, 0910, me starting an IV in a new place in this patient's arm and pushing a few IV drugs through it:

"Yeh, so anyway I told my oldest one there that I didn't need no doctor's visit, but he was right 'cause here I am gettin a heart valve replaced. But the doc said that it'll last 10 years so now my son is sorry i betcha cuz he won't git rid of me for a long time now! Hey, YOUCH! What're you doin in that arm anyway?"

"I just put in the new IV, the needle is out now its just the plastic cannula in your vein."

"Okay, so anyway I tell 'em last night I wanted some ice cream, but they didn't bring me any."

"I could go for some ice cream right now."

"what! you kids! it's 9 in the morning!"

"Well I'm 5 months pregnant so I can have ice cream when I want to."

"Aw well I guess I that's true. Can't argue with that logic. When I married my wife she had 3 children, an' I had 2 childrens, and then we had another children, and they was an army. I mean an ARMY. 3 girls and 3 boys. Yessir that was my oldest son I was tellin you about. And that was 39 years ago we got married, and we're still married, so we did something right. You know when you can stay together with that many kids and trying to merge two families you doin something right. And then we had a baby. You know I'm not a religious man, you know I'm not like some where I go off believin' in some myth about some thing or someone or some religion, but babies, I mean, wow, babies are just... just... "

"A miracle?"

"Yah! Babies are just miracles. I mean, you got you there, a person, and your husband over there, a person, and then you mess around, doin' married people thing, and BAM! a new life. I new formed separate person. Just like made and different and unique and just a new person. there is just no explanation for that anywhere, how that happens to be, well except for maybe.... but like I said I'm not religious. but there's just no denying those sorts of things when you look at a baby."

(i switch vials to the next injection)

"Yessirree and those birds in the nest, they do whatever birds do to make eggs, I don't know how birds do it, but they do their thing and there is precious little eggs up there a few days later. And then cute little baby birds come out. So don't you forget (he shakes his finger at me with his free hand) that that baby is a special, special thing. there is just nothing like that, and it is special."

"Yes sir!"

"Yup, my kids are an army. they are alright now though. i don't mind them so much now. it's kind of nice having so many when you're an old feller like me."

more illness

so, in another attempt at team building at work, we all subjected ourselves to the same nasty cold/flu virus. at the same time. because we are that much of a team.

sometimes i think maybe we take this whole 'month of team building' thing too far.

anywho, every. single. person. was out sick on the same day. from our desk clerk to aides to RNs... so like, anyone who was trained to do anything or knew anyone. which is kind of a bad thing. ive never seen that happen, like everyone out on the same day, at any unit i've worked at before. the next day, me and LV2.0 made it in and at least tried to catch up on paperwork and the 110,000 phone messages, but by 2pm we were delirious with fever. we had drained an entire bottle of cloraseptic spray, later learning the directions say DO NOT SWALLOW. then we spent five minutes trying to figure out how to not swallow chloraspetic spray. in this process we swallowed more chloraseptic spray. we also decided luden's cough drops are superior to ricola in staving off nausea, but ricola actually helps suppress coughing.

a few of our docs are sick too, but i dunno what is up with doctors. it takes like a black plague or something to keep them away from work. they just keep going. they never call in sick. it's...weird.

our boss was gone for the day when we came back, so we didn't really know who had been filling in for us or if they had just rescheduled patients or what. doctors are really nonspecific about who helped them out the day before, like "some girl with brown hair" or "i think hes an xray tech on the night shift". come to find out it'd been some temps, and that they didn't really do a lot of anything while we were gone. except either hide or steal our good lotion. most likely steal. jerks.

here's something you should know about nurses and the nurses station and a nice bottle of lotion: that bottle of lotion belongs to the nurses. the hospital didn't provide it- those nurses chipped in and bought a bottle. that brand specifically was decided by committee, declared to be the best lotion, so you know it's the best lotion like, ever. and why would you take the lotion that people use all the time to soothe their aching hands from washing them 200 times a shift. because you're a mean, mean person.

now i've faced the lotion lift caper before, and it's now common knowledge that anything left on the clinic counters overnight the ukranian cleaning crew considers fair game. which is why we created The Bogey Lotion.
The Bogey Lotion is the 6 year old vaseline lotion that smells like grandmas* and nobody likes. There's also a similar Dove bogey lotion in the most accessible desk drawer. this lotion is kind of meh, like we would still probably use it as a second choice but if it was stolen it wouldn't be the end of the world. but OUR lotion, our lotion is kept in the secure cabinet! next to boring batteries! which is hard to get to (especially if you're preggers) because you have to lean over the printer to even open and reach into said cabinet!

anyway as i was saying, by 2 pm we were both really, really sick. and 2 people doing the job of 5 was not going well anyway. luckily the afternoon clinic was rescheduled because in the morning we still had our sanity and enough foresight to do so. then we took turns taking a nap while one person covered the desk. as i laid on my side (i remember the days when i could sleep on my back, i miss that) in a corner of one of the doc's offices, on the floor, on a pillow from an exam room, with a blanket from the blanket warmer, i was like really feeling like i wanted to die. but i was like, no, i have to finish drinking this water bottle. then finish sucking on this cough drop, and maybe then the burning sore throat will get better, and my stomach will stop turning, and i can stand up again, or i can die. whichever happens first. then i thought, wait, there's probably MRSA on this floor. so if i do survive, i'll probably have mrsa on my hands. so i need to wash those when i get up. but then i won't have good lotion to put on my hands, so maybe i should just give up and die and succumb to the virus.
then the next thing i remember is my cell phone alarm ringing wakeupppppp. the rest of the shift is a blur, but i do remember stumbling to the car josh picked me up in, so i must've made it through.

i'm back at home today, fever and my asthma preventing any heroics i would try in regards to go back into work again. or from like, standing. and breathing sometimes. i doubt anyone else from my team made it back either, so you know what that means... bogey lotion is probably gone, too.


*see teen girl squad reference Issue 3 - the thrift store.

clinician

wow i barely made it through these five days at work. too many patients, not enough staff. hardly any breaks, working well over my shift end time, it's ridiculous.. if it weren't for my patients, i wouldn't do it. but i like my job... just not the hours.

sometimes hippaa is lame, because i wish i could tell the whole story on these patient stories, instead of pieces of them, because they are amazing. and there are also ridiculous stories, and sad ones, because people are sad and ridiculous. but anyway, here is my attempt to be vague.
as i review the moments from the recent past, it's an assortment:

-crack user blew heart valves out (yah cocaine is bad for you big surprise), saw a variety of arrhythmias go by in a few minutes when he presented to walk-in clinic, and had at least 45 lbs of extra water weight on. i think he was breathing out water vapor bubbles, that's how much was in the lungs. also in renal failure, came for help too late, died that evening in the unit. oh and thank you to Charge Nurse #1 over there for stalling his admission for 4 hours because "I don't want no druggie on my floor" - you. are. a. douche. he has a family and people who care about him, and they came in right away when we called. they saw a person they once knew, not a druggie.

-felt the joy of sharing with a long time patient "heart function improved!", a miracle none of us in our office expected for this patient, "enjoy some water and salt again", enjoy your grandkids without a dim prognosis hanging over your head so much. doc said "yay betablockers & CRT", i say it is nothing we do, really, there is Someone who knows the number of our days.

-long time heart failure patient who did have a stabilized EF of 45 for a long time came in completely decompensated with signs of a stroke?! still not sure what caused the stroke but echo shows EF 10 now. two weeks later now, still no known cause of heart failure, no for sure cause of CVA, etc... brushed up on my spanish to talk with patient, will not be able to work the fields anymore (migrant worker), is still very young, will refer to transplant or mechanical heart - if he wants... doc asked "thought migrant workers didn't have rights/insurance in this country? corrected him, patient was born in the USA, just never left "little mexico" of our county, never gone to school, or learned english. parents needed him to work the fields with them.
at the end of the day after a bunch of outpatient testing, was drawing tubes and tubes of blood trying to explain what each was for.... the biggest tube is for pre-transplant antibody screenings, it's literally a tube like the size of my arm.... 'antey, bodes'? que es?" he asked . . i said, "let's just hope you don't have any of those" as the tube filled with murky red.

-filled out five disability applications for five different men, all who want to keep working, all who can't perform their job anymore due to heart failure. one of these is a laborer, and has been in denial for the four years i've known him about his limitations. he lives in a rural area, and has been shocked by his ICD over 20 times just from pushing himself at work. (ICD is an implantable defibrillator device that shocks you out of a sudden death arrhythmia. you can imagine how many times we've changed the battery.) that's right, a literal zap kick (that is so painful and will push you to the ground) in the chest over and over did not stop him from going back to work. it also doesn't stop him from driving himself into clinic when this happens instead of doing the right thing and calling 911... but anyway. now his heart is getting worse, and we've tried everything humanly possible to fight his heart failure, except transplant/mechanical... now he's short of breath, can't walk without panting, and can't lift things anymore. barely 40 years old. still have not met his wife, wondering what she thinks and if she cares? or if coming to the doctor is just too difficult? or what?!

-college girl discharged from hospital after arrhythmias resolved. doctors & nurses had grilled her there, found no drugs, no OTCs, no stress in life, no recent infections, everything great, no known cause for arrhythmias. 2 days later comes to clinic for outpatient testing. as i checked her in, had a lot in common. had the same shirt too from Old Navy. liked the same soda. had the same opinion on the blah winter weather up here. same height, same weight. asked my general screening questions before putting her on the treadmill (while watching PVCs go by ballistically on the EKG) ... "Well don't tell anyone but me and my boyfriend do meth sometimes. I think that's why i had this heart problem, but im totally not going to do it again." a few minutes later.. "oh yes, I do use diet pills, do those affect your heart??" a few questions later... "yes, i do like the Rockstar energy drinks, i'd say like, 5 a day, or 3, i dunno. sometimes a different brand."

-saw routine follow up on a 30-something heart failure patient, had normalized heart function for the past year, echo didn't even look like someone who had ever had a heart condition, really no reason to follow up with us as often, continue current meds, see us in six months... doctors very happy with patient's "healed" idiopathic heart failure. 4 days later call from the coroner, sudden cardiac death, in his yard, when out enjoying the first few rays of sunshine to come this spring. wife found, but already gone.

-severe end-stage alzheimer's patient comes to clinic for check up, which is something we rarely see, come to find out family dragged patient in. family demands fix for patient's heart problems, that that is what is causing all of patient's problems. i don't even have the energy to argue with them or even respond to their "Chief complaints". i look at the patient, almost completely vegetative, unresponsive to the world around them, and sigh. tried to find a place to take blood pressure, extremities completely contractured. not sure how the aide had dressed them in the morning - it must be quite a task. wondering to myself what kind of lift they use at the nursing home to get them in and out of the very large chair. realized i stopped listening to the family like 5 minutes ago.

-watched my mechanical heart patients walk around and around the hallway, some flirting with the nursing assistant who has them on an 02sat leash for their six minute walk test. made my heart happy, because i remember last year when they couldn't walk, or hardly breathe, or eat, or be outside the hospital. now they're at home with their families, they all had a good Christmas, they are doing Wii Fit and going for walks outside.

obesity problem

The Colbert Report	Mon - Thurs 11:30pm / 10:30c
The Word - Manifest Density
www.colbertnation.com
Colbert Report Full Episodes Political Humor Economy

this made me laugh!

i needed to laugh after today's shift, especially because today i had 10 assigned patients... 8 were severely morbidly obese. MORBID. that's a category... the fattestly fat.... it's like beyond obese. it's like beyond that i'm overweight typical american. it's like, crazy, crazy, how does that happen to a person. i had to find special wide wheelchairs that we didn't HAVE. we had to borrow them from a separate CLINIC by calling around asking who had these kinds of wheelchairs because all of our wide ones were in use! one patient we had to find a giant bed for.

and then on like half of thess patients, the MD ordered echocardiograms. Like, seriously?! You think a tiny ultrasound wand with ultrasonic waves will be able to see through all of that tissue?

seriously people. seriously. what is up with that. but according to this report, it's good for the economy, so, i guess i'll just charge their echo bills to their state funded medicaid. state heathcare, it's free, right?!? magic!!

#the empathy is gone when the shift is over

appy new year

last year i used my ipod touch tons, and a few of my blogging friends have been sharing what apps they have, so i thought i would share what i have on mine. i use my itouch a lot travelling, in the car, cramped spaces where i can't do anything else, and also at work as a pocket PC, so it has mostly apps and music, and not much else. for some reason lately i have not been able to sync movies with it, which is annoying.

anyway here they are

by the way these are all free


for work:

MedCalc - use it all the time for calculating infusions, BMI, BSA, dosage calculations. So. Awesome. it even has quick buttons for stuff like glasgow coma scale, IV drip rates, unit conversions, etc etc etc. it's totally sweet, and i hate dosage calculations and second guess myself a lot (especially with dobutamine or milrinone drips which i manage frequently) so it is super awesome.

Calculator & Clock - i know it comes with it but i use it all the time! the clock, It has a second hand! I dont need to wear a watch anymore! Yes!! Seriously, I don't wear a watch. For those of you who aren't RNs that may sound like whatever, why would you wear a watch, but i've been in nursing a long time and always hated wearing a watch but always had to wear a watch and was always fearful of my MRSA laden watch. No more. also no more calculator clipboard combos lying around.

Epocrates - handy, handy, handy pill identifier. working clinic days my patient always says "well i take the purple pill but i don't know what it is for, here you go"... i seriously have a few patients a week bringing in bottles of unidentifable pills. 9 out of 10 i can identify and then verify with the PharmD.

Notes - also came with the itouch, but so handy.

MPR - helpful for quick prescribing / look ups... i know by heart the dosing for beta blockers, arbs, aces, statins, lovenox etc. but oftentimes when you have worked in a specialty so long we all end up looking at each other when we have to remember how to prescribe a simple antibiotic. uhh amoxicillin comes in what doses?? for how many days? whats another name for benadryl again?

Eponyms - ever wonder what all those names of disease and tests Dr. House throws around on TV mean? or in my case Dr. Cardiologist i work with who seems to know every bizzare test or strangely named condition to test for? Allen's test (ok i actually know that one because i use it a lot before radial caths), Carvajal syndrome, Gregg effect, Landolfi's sign, Louvel's sign, Virchow's triad... "yes doctor i know exactly what you are talking about of course... as soon as i search for it in eponyms..."

Google -- hey, what? sometimes i forget what the different between hypo and hyperthyroidism is. or i want to know the name of that actor who played in that one SyFy show that one time. and look it up while at work. on company time. to win and argument with a coworker.

XRayFX Lite - k. not medical at all. it totally makes your itouch look like its taking an xray of your hand. ive used this with both pediatric and elderly patients if they are super tense and we just aren't hitting it off, especially if i have to do something invasive or uncomfortable like a tough IV start, or something like that. the old people think it is real at first, which is fun. well for me. there is one guy out there who still believes my itouch can xray hands because i was interrupted before i had a chance to tell him.

flashlight - cuz sometimes it is dark. in there. in that patient. i do have a penlight type LED light on my stethoscope, but this bright white light is kinda nice too sometimes. this may sound weird but vascular clinic days we monitor patient's LE ulcers with digital photos, and ive used this to help with the lighting... yah ok that does sound weird to say outloud.

the epocrates disease game - ohmygosh the grossest diagnosis game EVAR. but so addicting. i played it on a long bus ride once, probably not the best combo with motion sickness. is it atopic dermatitis? psoriasis ? seborrheic dermatitis? they will give you an actual picture to guess from. but you only have 30 seconds. usually i am guessing having no idea (pathophysiology 101 was a long time ago) but it feels so good when i am right! ha!! aortic coarctation!

Auscultation - pretty sweet app that takes you through the sounds of cardiac, pulmonary and abdominal auscultation exams. i have such a hard time with my cardiac heart sound exams, and differentiating types of murmurs and stuff, that im hoping my listening to this every now and again will help me out. it has already helped with my problem with figuring out bruits.

there are a few other drug look up programs on my itouch, but i havent used them lately. usually epocrates suffices.



for funzies:

weather -- my favorite. i love weather! i have a few weather apps. some are more detailed than others. the simple weather one is fun enough for me most of the time, i have preset the weather in like a bunch of random cities everywhere around the world, and i like scrolling through and looking at what the weather is like in those places. pretending i am there. i also have it set to cities where friends and family are, like seattle, LA, oklahoma, dracut :) just for funzies.

Google Earth -- sooo cool. even though google earth is like so five years ago, i still cant get over teh awesome ness of it. i can see my house!

Uno - Uno! Everyone likes to play Uno!

TapWord - basically boggle. but with a cool middle eastern techno beat. ya yah!

iReversi - it's othello

Blowfish -- cute little blowfish! floating around! you make them grow to block stuff and whatnot, its fun, but im bad at it

Falling Gems - by far the best itouch game, most well loved, well worn game on my itouch

Hangman - play this with family a lot

Crossword - meh,its ok. not as good as i thought i'd be but im too lazy to look for another crossword app

paper toss - reminds me of my cubicle days. i love this app

pac-man -- yay!!

lightsaber - fun! zap, zwoosh, zap! you can choose a couple different types of light sabers, and then wave your itouch around making light saber war noises.

Dice Roller - this is good when you need dice, but you dont have any. like you dont have to worry about losing the monopoly dice anymore.

fish tycoon lite - i like looking at the fishies. i dont have any real pets at home so y'know

20 Q's Mindreader -- it knows! it always knows the answer! except when it doesnt

waterslide extreme - the graphics are so cool, coolest waterslides ever, one of those tilt the itouch games. and i was delighted to find out i could totally make my person fall out of the slide and die. so realistic! (and adding to my already huge fear of real life waterslides... now im even more prepared for next summer!)

Unblock Me - i like this puzzle game! it keeps me occupied. it makes me think.

Whac-a-mole - reminds me of chuck e cheese games. :) its fun

TouchPets - i have a cute virtual puppy. that is severely neglected. reminds me of nanopets back n the day

Glow Hockey - fun air hockey table game, cool lights and cool sounds!

Solitaire -- still love this game. i have like 8 versions of it including spider

ragdoll lite - addictive and ridiculous

iBloom - i have no idea how i got this random app but it has pretty flowers on it

Jumbline Lite - wordsearch type game- fun

wordpopper - nother word game

word dash - yet another word game!!



other stuff:


QuietNoise - the cheapo version of white noise. ahhh.

urbanspoon - find noms at your current location. there is probably a better restaraunt app out there but im too lazy to search for one.

flickr - you know i love my flickr friends!

remote - its an apple remote for my mac, or any mac nearby

kobo, beamitdown, kindle, etc -- all for downloading and reading ebooks. all of the books i have downloaded i have gotten for free!

SnatchTest - turns the itouch screen into a mousepad for any nearby mac, i.e. our mac mini that is hooked up to our TV

iTranslate - translates. like. everything. into anything. from anything.

Bible & Logos - a bunch of versions of the Bible, and also it lets me access Josh's logos library (a lot of books)

GuitarTuner - it plays each string so you can tune your guitar

iHandy Level - level

Mars Hill - streaming access to my old church's media stuff

Nike Training / Nike ipod - workout routines and videos and whatnots

Errands - make lists of stuffs you need while you're out. ive never used it but i keep thinking someday i might use it.

facebook - for being on the facebooks

echofon - for being on the twitters.

the pharmacy answering machine

due to the nature of my job at the clinic, what with managing medications all day for patients, and doing refill requests, i leave a lot of messages for pharmacists during the day.
i have all the local pharmacy #'s memorized, as well as our Doctor's DEA #'s and UPINs and licenses and all of those things.
I also feel that me and the pharmacy's answering services have an unspoken agreement, a code, if you will, that allows me to leave quick and prompt messages without having to listen to their various robotic prompts.

i.e. Rite Aid - all you have to do is press 4 to leave a message. you don't have to listen to anything, just 4. 8 if you want to talk to someone.
Walgreens? 1 and then 1. and then pound to skip the "State your name, title, dr's name, patient's name and date of birth..." instructions. Boo. yah. Carvedilol 6.25 mg bid #60 called in no prob bob.

Well, Yippie Dippy local pharmacy decides to change things up today! What! What is that about!! No more 5 and then 2 and then 1. So first i had to listen to their message about how they are out of flu vaccines and how h1n1 is still not available. yes yes, we know, we know. then i had to listen to their "season's greetings!" message about some local special screening clinic. then I get a long list of prompts in which the doctor's office option is 5. 5? seriouslY? after recorded directions? lame.
Then, they don't let you skip their instructions for leaving a prescription on the line. Seriously, if I didn't know how to do that by now, .... I mean.... I call in prescriptions in my sleep. "Mumble, mumble... lisinopril 2.5 mg... hctz 25 mg qd #30... mumble mumble".

So they totally threw off my roll man, my roll.

only a clinic nurse could appreciate this rant i'm sure.

demented

this week i've had the most demented patients, i mean just clueless as to where they are and who they are and what they are doing.

i think i'm tired of being a nurse, like, a lot. i'm a nurse most all of my week, even at chuch sometimes. i had a quickie recurrent parox afib consult at prayer group on tuesday, a reassurance therapeutic conversation pre-angiogram between Sunday school and service on Sunday >20 mins.
on the other hand, some of these patients are super cute, like old man confused but adorable cute. like can't help but take of him reminds you of your grandpa cute.

Jen D. (er wait, L.) says she's the queen on procrastination but I'm pretty good at it, too.

Today I will force myself to go to some wal mart or target or other godforsaken store and buy socks and new scrub uniforms because mine are coming apart at the seams and my socks have giant holes in them that are too big to ignore.

I don't know what it is with me and socks, but I just hate buying them. I hate wearing them more than buying them but I have to wear something in between my foot and my shoe. Why can't nurses wear fuzzy bunny slippers all day.

Dear Patient

Dear Sir or Madam,

I see you almost everyday. You are in the hospital as an inpatient. You are at the pharmacy counter. You are in the waiting room. You are calling on the phone. You are in clinic for an office visit. You are in the procedure room for your surgery. You are in the infusion room waiting for me to start your IV. You are young or you are old. In fact, sometimes I see you at church, or at work, bible study, or other places. You just pop up everywhere and you take. This week I have seen a lot of you.

It doesn't matter to you what your family has done for you, how much they care about you, what your nurse has done, how much your friends listen to you, people who stay at your side through thick and thin - you are never satisfied. You are better than everyone and deserve all of the attention and the world revolves around you. At the very least you are more intelligent than everyone, which makes you better in any event.

If something isn't going the way you would like it you sometimes scream and cuss. Sometimes you get all passive-aggressive and sulk. Sometimes you cry and whine. Sometimes you abuse.

You "don't deserve this!" and you "deserve to be the center of attention" and "people should be paying attention" to you because of your:

a: horrible disease
b: how much pain you are in (1. physically 2. emotionally 3. both)
c: how hard life is for you because of your (1. social disorder 2. disability 3. addiction 4. economic problem 5. relationship status 6. children 7. chronic disease 8. general burdens in life that are unique to only you of course)

Also, you have made it quite clear that no matter what we do, or how long it is after you are well, no matter how much we listen and care, you still need all of the attention. You still are never satisfied with anything or anyone, and nothing is good enough. And you can't believe how dare someone get more attention than me, how undeserving are they, you are better and more important than they are, you have been through so much more. I mean, you don't actually know THEM over THERE, but obviously you are much worse off. YOUR call light is more important than theirs (so what if it's a code blue?), YOUR phone call is BETTER than THEIRS. Your prayer request is the MOST URGENT.

We should feel so sorry for you, and just give and give and give.

6 months later at your office visit, or your coffee visit with us, or wherever, it is still the same. You have all these problems, and they are more important than ours. You have made no effort to change anything in your life (you have heart disease but you still smoke, you have relationship problems but you do not have standards, you have spiritual problems but just can't find the time to go to church, you have addiction problems but can't change your habits, you feel lost and alone but won't read the Bible, you have diabetes but you eat carbs all day) because you have a ROUTINE, and YOU need it, and you are too important and too busy to change these things, or you just don't want to and you have the BEST excuses. Besides, this is OUR fault, at the very least we have to hear about it and BE EMPATHETIC to YOUR needs. WE "just don't understand" YOU, we don't care enough, we don't know how hard it is.

Sometimes your problems have been solved, but only replaced by new problems. We remind you now that you have that job or relationship you've always wanted, but you remind us how stupid we are. THAT didn't make you happy (even though you said that was all you needed), in fact it only caused more NEW and AWFUL problems.

You call the office constantly, you schedule meetings with your pastor/teacher/doctor to whine so you can feel better about yourself afterwards, you update your facebook status everyday with a new woe just to let everyone know how hard life is for you each day (and this is good for fishing for a quick sympathy fix), you call and text your friends or you stay at home and shun them on purpose.

You hate other people who are like you, because they are getting attention. You hate people who aren't like you, because they aren't giving you attention. You aren't involved as a volunteer, you aren't involved in the community, you don't give to charity (unless it's for tax write off), your first thoughts are of your needs. You neglect your life partner and take people for granted. You alienate friends and avoid making new ones because people are "so needy!" and you can't stand to listen to them. You are offended that your pastor asks you to come to church on Sunday, much less WORK in a MINISTRY. You are offended your doctor asks you to make simple life changes that impeded on your preferred diet or lifestyle. You say God is important but He is your last priority. You are good at manipulating people. You are a control freak. You are lazy. You keep people at a distance unless they suit your needs. In fact, in general, other people are very annoying and pretty useless to you unless they "mesh" or "click" with you and contribute to your needs.

You don't make friends or make an effort to care about other people that annoy you. You don't want to get involved with church because it is full of people who are annoying and don't understand you. You don't give and love your family because they are annoying and they don't understand you. You break off relationships or ignore the current ones because they are too much drama for you.

If one thing in your life goes wrong, everything is wrong. You try to compartmentalize to avoid this, to stay in control. You let everyone know when something is disappointing and out of your routine and how inconvenient it is, but you are incapable of being transparent and letting people know when you are a depressed and lonely.

You are selfish.

You are nearsighted.

You are inward focused.

You are a taker.

You are a breaker.

You are blind to your need for a Savior.

You are sinful.

You are jealous.

You are prejudice.

You are hating your neighbor.

You are unaware of your need for a Savior.

For all have sinned and fall short of the glory of God,

but you think you'll hold together forever.

You know you're low, but you play so high.

You can't play as your own God forever.




I've seen about as much of YOU(s) as I can stand this week. I'm your pastor's wife, I'm your nurse, I'm your friend, I'm your neighbor - I'm not perfect. I do these things too, I'm selfish by nature. But you, YOU are everywhere! We need less of you. I need less ME in me, too, and more God. Why can't WE look outside ourselves to others? Why do we look at other people and see "ANNOYING -- " instead of seeing someone God loves? Someone who is a good friend? Someone who care about us? Why do we spew hate and not love?

And you who have no excuse? Who have been a "CHRISTIAN?" What is the deal?


You remind me of a Keith Green song ==

Do you see, do you see
All the people sinking down
Don't you care, don't you care
Are you gonna let them drown

How can you be so numb
Not to care if they come
You close your eyes
And pretend the job's done

"Oh bless me lord, bless me Lord"
You know it's all I ever hear
No one aches, no one hurts
No one even sheds one tear

But He cries, He weeps, He bleeds
And He cares for your needs
And you just lay back
And keep soaking it in
Oh can't you see it's such a sin

'Cause He brings people to you door
And you turn them away
As you smile and say
"God bless you, be at peace"
And all heaven just weeps
'Cause Jesus came to you door
You've left him out on the streets

Open up open up
And give yourself away
You see the need, you hear the cries
So how can you delay

God's calling and you're the one
But like Jonah you run
He's told you to speak
But you keep holding it in
Of can't you see it's such a sin

The world is sleeping in the dark
That the church just can't fight
'Cause it's asleep in the light
How can you be so dead
When you've been so well fed
Jesus rose from the grave
And you, you can't even get out of bed

Oh, Jesus rose from the dead
Come on get out of your bed

How can you be so numb
Not to care if they come
You close your eyes
And pretend the job's done
You close your eyes
And pretend the job's done

Don't close your eyes
Don't pretend the job's done
"Come away, come away, come away with me my love
Come away, come away, come away with me my love

laminin and black holes

The last two weeks in Bible study we have watched two videos by Louie Giglio because we are in-between Bible study materials. (Our next study is a John Piper study which I am really looking forward to. But the books haven't come in the mail yet. Lame, publishers, lame!!)

The first video was called "Indescribable" and he talked a lot about space and showed pictures of different galaxies and amazing awesome universe things to show how big the universe is. This was one of those "whoa, weird" moments for me because I had JUST been perusing great space photos the DAY BEFORE! Which you can see on my October 6, 2009 blog entry. I had literally wasted like 3 hours just reading about galaxies and novas and been in awe of God's universe. All by myself. Without some preacher guy I don't know pointing it out to me. Anyway, yes, the next day our Bible study was on the indescribable beauty and awe and expanse of the universe and how even bigger and amazing God is. So keep in mind I was in awe and had a "wow God!" moment before the last five minutes of the video came on.

Which you can watch the last bit here by the way if you want to.



He describes how an image of the center of the Whirlpool galaxy popped out at him from 31 million light years away (okay I'm paraphrasing really bad you should probably watch the clip) and alas! alack! it is in the shape of a cross! His jaw dropped open! He fell off his chair!

Meanwhile, I am staring at our plasma TV displaying the image quite nicely (because the video leaves it up there for quite awhile) and I do NOT see what he is talking about. Like, I really honestly don't see it. And I say that to the three other people next to me, and Josh tells me to go put my glasses on. But that's not really what I was saying. I SEE the "X" that made the impression on the speaker, I SEE the white, bright, kind of sideways blobby type cross and can understand why someone who had cross on the mind would say, "hey! that's sort of cross looking!"... but I don't SEE like Giglio sees.

I was really tracking for the most part up until this point, like emotionally tracking with him - wow, awesome, God is the Creator - the Maker- the infinity - amazing! It was like God had been directing my thoughts even before this video, maybe to prepare me to be more in awe of Him, because of the all things I had read and looked at about space before the video. Sure, the background keyboard sensationalist muzac to stir emotion in the crowd was super annoying. The mere fact that I was tolerating the speaker to this point was actually quite phenomenal because I usually find the gelled-hair on TV with their own worship band on tour types annoying and certainly not enough to invest emotionally into what they are saying. But it was a good talk. Until... until the blobby white and black shadow cross thing. Which to me did not look like a cross at all, I even tried to imagine what he must be seeing, but I could not see it.

And then after I opened my mouth and said something, which I tend to blurt stuff out without thinking, I was met with three pairs of eyes that all seemed to say, "Well, we see it. What's wrong with you."

So I was a little miffed and tried to forget about it, but it still bothered me the rest of the week. Why didn't I see it? Am I that cynical? Am I what some of those prophet writer guys in the Bible referred to as stone heads and blind eyes and stuff? Am I supposed to be seeing Jesus symbols in my everyday life to be reminded of God?

And then there was the second week's video. Which kind of set me over the edge. Here's a clip of the last few minutes:



Now first of all some positive points about this video:

I enjoyed it up until the last eight minutes.

He spends most of the video talking about planets that have been discovered and then lines them up in order for HUGENESS and it was so awesome! I mean like our sun? In our solar system? Is like a tiny speck compared to these planets. How insignificant I felt when I saw those on the projector screen... and yet God knows me and made me. This would have been enough for me. Giglio could've (and should've I would argue) ended his talk right there. How great is our God, and yet he sent his only Son to die for us on the cross (not a shadowy blobby thing in space camera vision but the actual Roman crucifixion cross). I do love that he reads from Colossians and mentions the supremacy of Christ, etc. Why not preach about that? Why not read more scripture?

But no. Noooo. He has to end with his "left hook" and go off on a laminin tangent. You can read more about laminin in the links below, but basically it's the protein or "glue" that holds our cells together. Colassians 1:15-17 is mentioned to make his point - Laminin looks like a cross (in scientific diagrams), Jesus' symbol is the cross, laminin holds life together, Jesus holds life together ("and in Him all things hold together"). Therefore laminin = Jesus.

This time I "SEE" it. Yup that's a cross alright:



But I immediately see something else that I see often in my field of work:



In my mind, laminin does not equal Jesus symbol. Yet again my mind screamed "sensationalism! this is wrong!" but I held my tongue. He had completely lost my interest at this point, mentally and emotionally, and the piano/strings keyboard patch was grating on my ears. I sipped some tea and shoved a few jalapeno pepper jelly tartlets in my mouth to calm down. At this point I'm thinking to myself, this guy really believes in what he is saying, he really sees God in these little things. He sees illustrations to share Jesus, genuinely, with young people because he cares for them and their souls and wants them to know God cares for them, they aren't insignificant, God knows every hair on their head and every tiny cellular structure. This is important for people to hear. How could I be "irked" at this guy for wanting to share God's love and desire for us to be in a true relationship with Him.

How could I...

Well I am. Later I went on the internets to look up laminin to make sure Giglio's molecular biologist friend wasn't pulling my leg. I was surprised to find this video was pretty popular on the internet awhile back as an inbox forward and link to your friend type thing. There were even Christian bloggers who have blogged about it before me.

This guy's blog post I ran across made me think in a less cynical light. He certainly sounds a lot smarter than me. I do not have a lot of background to go on for Bible stuffs... I never went to Bible college. My daily devotion time is just reading the Bible and praying, no study guides or smart books. Everything I've learned about theology and doctrine is from kind of half-ass Baptist sunday school classes and really good far and few in-between theology books (which I do not think I absorb as much as I should from and have to read over and over to understand) and more recently, my really awesome husband who knows stuff, and also lots of podcasts from preachers and professors. I also observed a lot apologetic type discussions on the RI, when it wasn't about "I Kissed Dating Goodbye"... and those friends are probably the opinions I would go to for this kind of thing. Which is mostly why I am posting this blog (I'm talking to you James Rhea and Miss Cassie) hoping to gain insight.

So this guy, whoever he is because I didn't bother to read the rest of his blog, poses some good questions about the laminin talk:

So, does this disqualify the teaching as irrelevant or inaccurate?

I would suggest, “no.” Why? Because a spiritual experience is always esoteric and interpretative. Crafting a connection is part of the gifting that God seems to give to communicators (like Giglio), and instead of criticizing its accuracy, we ought to be applauding its ability to move people, bring people to a sense of awe, and wonder.

I was with a surgeon when I saw Giglio give this talk, and she said that she of course knew about laminin but never put the two together the way Giglio did. She felt it was an “interesting” interpretation, and yet was still moved and touched by the commentary our biology was seemingly making on the realities of our existence. Whether or not Jesus’ cross was actually that shape was irrelevant. The point stands on its own without the need to clutter it with historical criticism. And that’s okay.

and....

Is it then reasonable for someone to be skeptical, even apathetic towards these kinds of endeavors?

Sure. “This is a free country” as they say. But through these talks I suggest that the best way to be human is not to deny ourselves the search for significance, casting it aside as some sort of evolutionary fluke, but rather embrace our nomadic wandering through the universe as something to fill our souls with meaning. What cannot be denied is the experience, and I suggest that phenomenology is evidence that humanity desires to be anchored in something meaningful and moving. And that desire, that drive, is never going away.

Eh, maybe not so great answers to these questions. I wish I could come up with better answers but I do not know how to form my thoughts further on the subject. I guess our personal experiences with God are all different, much different, and what drives our desire to seek God are different. And we have different spiritual gifts and see things different ways.

In my life, the more I learn about science and the human physiology (which is something I study for hours everyday), the further I am drawn towards a relationship with God and the firmer my belief in God cements. My faith grows, but not because I see little cross shaped cells and see SIGNS and WONDERS in the universe in a magical, sensational way. It is because I see we are fearfully and intricately and wonderfully made. It is because I see that the universe is indescribably ginormous and I am completely stupid and should be less then an amoeba on God's scale, but he knows me and cares for me, even the stupid stuff, and cares for the little birds and probably the little amoebas in the swamp even though Jesus didn't happen to mention those things in His talks. I am but a vapor. We cannot even grasp the basic mysteries of God's creation.

So, is it wrong for this guy Giglio to go off on his signs and wonders kick and preach about Jesus symbols? Honestly, I don't know. Probably not. God used tons of signs and wonders with the Israelites and they forgot about Him like, what, two months later? If Mr. Giglio sees Jesus in small things, and is reminded of God in cell structures, how different is that from me seeing God's hand in tiny details of my life like when I say, "God provided this flour jar when I needed one!" when one appears on the free table at work and I take it home. To someone else that is a happy coincidence. To me that week it was an encouragement, a reminder that God provides and cares for even the tiniest thing in my life.

Grace. God gives us grace, especially our feeble attempts to understand that which we will never be able to understand, and describe what we will never be able to describe. Grace is important in the Christian life. Josh tells me a lot that Christianity is like looking at a diamond, everyone has a different point of view on it but it is still the same beautiful diamond. Okay I am totally butchering his metaphor and you will have to ask him. It was something about when he talks about different denominations. Wow I am really butchering it. Okay I'll stop now.

I did run across a lot of people on the internets who easily turned Giglio's laminin talk into "Jesus is magic!" and totally shredded his point- like, wow! Laminin looks like that thing from Greek mythology! The Greek gods are really true! Long live Zeus! and just totally made fun of him and stuff...which is why I think he should've just stopped his talk before the Laminin thing. It's a weak point to end on, I think. God gave us scripture for a reason.

BREAST CANCER AWARENESS MONTH WTF

OKAY -- ATTENTION -- I BELIEVE IT IS TIME FOR MY ANNUAL BREAST CANCER AWARENESS MONTH RANT----

i.e. http://www.nbcam.org/

Honestly, I don't know why it annoys me so much. OH WAIT I DO.

Maybe it is because of the local hissy-fit over it every stinking year.

It starts with annoying melodramatic radio ads.

Then the TV ads with the pink people running relays for 3 days.



Then I go to the grocery store and not one, but TWO aisles are dedicated to "PINK!" "GO PINK!" -- pink water bottles, pink Mike Hard's lemonade (yes, alcohol), pink potato chips, pink t shirts, pink chicken marinades (!?!?!?!), --- AND THEY ONLY HAVE PINK SHOPPING BAGS!! PINK! Shopping!! BAGS!! No other bags to be found. In all of Haggens.



I drove by the local shopping center- the FORKLIFT was painted pink for breast cancer awareness.

I drove by the local Vietnamese dry cleaners - PINK ribbons on their dry cleaning hangers --

The celebrities are blabbing about it on every station and every little ceremony they make up for themselves even though they don't even know what they're talking about:


Oh i could go on, and ON, and ON! Pink everywhere! On yogurt! On brooms! On makeup! On alcohol! What the hell!!

LET ME REMIND YOU of the:

Top 10 Causes of Death for Women in the United States‡

The graph below shows how breast cancer compares to other common causes of death in women of all ages.

Top 10 causes of death for women in the United States.

The graph shows that the top 10 causes of death for women in the United States are—
1 Diseases of heart 329,238
2 Cerebrovascular diseases 86,993
3 Lung and bronchus cancer 69,078
4 Chronic lower respiratory disease 68,497
5 Alzheimer's disease 51,039
6 Accidents (unintentional injury) 41,426
7 Breast cancer 41,116
8 Diabetes mellitus 38,581
9 Influenza and pneumonia 34,949
10 Colorectal cancer 26,224

‡Source: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.govExternal Web Site Icon) SEER*Stat Database: Mortality – All COD, Public-Use with State, Total U.S. (1969–2005), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released February 2008. Underlying mortality data provided by CDC's National Center for Health Statistics.

Wait... what's that? The top two killers of not only women, but men also, are cardiovascular? Really? How 'bout that. Huh. Really. WOW. Wait... breast cancer isn't even the top cancer? Really? Wow! How 'bout that. Huh. Wow. Really.

So great... the Komen people or whoever they are are getting this great research funding... and they don't know how to find the cause of breast cancer. Oh and they treat it like other cancers with barbaric medicine and chemo and radiation. Oh and it comes back so your breasts get cut off.

On the other hand, there is preventable, PREVENTABLE cardiovascular disease!! You just have to be aware and get screened! Look at those top 3 on the graph - QUIT SMOKING.... KNOW YOUR CHOLESTEROL.... AVOID type II diabetes... GET A STRESS TEST.... CONTROL YOUR BLOOD PRESSURE.... GET SCREENED FOR ATHEROSCLEROSIS WITH A SIMPLE ULTRASOUND.

Still have a clogged artery, can't fight the genetics? We have stents. and bypass. and so many many many things... and none of it involves cutting off body tissues.

I mean, serious Seattle, Washington, United States, North America.... you have a top killer, far more deadly and prevalant than breast cancer, cardiovascular disease which is also mostly preventable, and you want to frickin smoke and eat and drink your way to death. And buy your smokes and eats and drinks in F'in PINK SHOPPING BAGS.

THAT is what annoys me at the store, and on the radio, and on the TV. All these well-meaning people running around with out of control type II diabetes and high cholesterol with their pink t-shirts on just waiting for a huge myocardial infarction.


at least some people try to fight the breast cancer consumerism... but obviously without much success. And these are women who have fought the cancer themselves!

Now don't get me wrong. I know a lot of women who have fought breast cancer and some have lost the fight. It is horrific, and personal, and just awful. I also know a lot of people who have had other types of cancer. Prostate. Colon. Skin. Many family members have died slow painful deaths from cancer. Research and funding is so important... but raising "Awareness"... by using consumerism? Swiffer? Alcohol? Pink shopping bags?

Ridiculous.

helper is helpless

i have had some really sad stories this week.
every patient has a story, but these ones are truly heartbreaking.
and there is only so much i can do, and so much the social workers can do,
and beyond that -

it's like,

okay i don't really know how to explain it. like this one patient, at the point in her life when her kids and family should be helping her and caretaking, instead they are taking her money and neglecting her and... TOTALLY taking advantage of her. I'm sure they have been abusing her, they are angry people, it's just sad. and she says things like "i deserve it" or "i don't say anything because i'm guilty"

i have noticed a recurring theme, and i hate to say it, but it is true this week with these particular people, these patients have made poor life decisions in the past and it is catching up with them. drug abuse, poor choices in relationships, addiction issues, quitting school, neglecting children... allowing people into their lives who shouldn't be. anger, resentment.

now they are facing end of life issues, and they are helpless to care for themselves and manage the things they used to now that they are sick and weak. through the 20s, 30s, 40s, they were able to take care of themselves. broken relationships, could handle on their own. not letting addiction get in the way too much, handle on their own. holding down jobs, handle on their own. dealing with their kids or troublesome boyfriends/girlfriends, handle on their own. making money, being successful, all on their own strength.

they didn't "need" God. they didn't "need" unconditional love. they didn't need a church. "I just wanted to be a good person, and I can do that and I have been." or "I just wanted to have fun, religion holds you back."

another patient was telling me "I thought I had time to figure out God Stuff later. And now I don't have time."

And really -- honestly, a huge part of my job is extending life. Transplants, mechanical hearts, etc. -- they all give you a SECOND chance at life. And yet this week I saw someone throw their second chance away with a second-round of alcohol/drug abuse. "It makes me feel good" "It's how I cope" ... "I feel overwhelmed, its the only thing I turn to" ....At that split second before facing your own demise, you'd think it'd change your mind, your heart. Oh look, my body can't do this living thing on it's own, I can't do this on my own, I cry out to who for help? That patient cried out to God. I heard them do it. Well here is their second chance, and they still try it on their own. When God is so THERE, I mean, like, so SIMPLE to turn it over to Jesus. Just rest in Him. Find forgiveness. Find peace. Find grace, real grace, the kind that is unconditional love, that changes you and your family, the God that answers your prayers, the One that is always faithful... It's not just your physical body that needs God...

It makes me think about the decisions we make when we are young, and how important they are. Especially relationships. Who we allow into our lives, and especially who we choose to spend the rest of our life with. Oh sure, falling in love is easy to do. Even getting serious and settling down, people can totally do that without God. Then you just figure it all out later, right?

Why not "figure it out" before? Why not have a real relationship with God, some real morality, and make good decisions for your future before you mess everything up? Why not let God in earlier?
Do they think He would've ruined everything? Ruined all their fun?

Wow what fun divorce was after having two kids. What fun finding out Mr. Right was Mr. Doesn't love God or you, maybe at first, until a sexier girl comes along.

What fun addictions were, and depression, and neglecting your children. What great things to go through alone and on your own strength.

What fun it is now to be alone. In a hospital bed. Talking about your life with a stranger, a nurse, who is paid to be there, who you just met yesterday.

swollen knee

Today was a long day at work. A ton of staff called in sick. I had a bunch of patients in clinic who had fevers and i was like STAY AWAY FROM ME SWINE FLU KILLAHS! Well, I didn't shout that at them. I just shoved masks onto their faces and left the room. Poor patients. But let me remind you, I do CHF clinic. Not fever clinic. CHF does not involve fevers. Ever. At all. Which is why I work with CHF patients.

That is probably why we have a lot of staff out, actually. Everyone is being told to stay home if they are sick, even the slightest sniffle and people jump ten feet away from you. Yup, swine flu has hit our county hard the past couple of weeks. And I still don't care. At. All.

Anyhoo, I don't work in infectious disease, I work in cardiology, so I ignored most of the clinic patients and worked on a lot of admissions for CHF or PTCAs. Although I did have one random head trauma admission that I stumbled upon. Like, literally, collapsed on the sidewalk and banged his head open and I was the lucky first nurse on the scene. It's happened before a few times that I've been a first responder like, wherever, and it always amazes me the lack of response and/or common sense amongst the common people standing around the victim. It usually goes as follows:

"Nurse! We need a nurse!"
"He fell!"
"We just found him like this!"

Meanwhile, the poor person is lying on the concrete with blood gushing out of his head. It looked like a frickin CSI scene or some Tarentino aftermath and I am immediately annoyed that no one is holding pressure to it and god knows HOW LONG his head has been gushing blood.

"How long as he been bleeding?" (as i use my lab coat to smoosh his head blood gushing gash)
"Uhhh... since he fell."
"Which was..."
"Uhhh.. " "uuh?" "Uuuh! A few minutes ago!"

The patient ended up being somewhat OK. At first he was not even oriented to anything, I mean he was on a spaceship and his name was Sally for all he knew.

SO annoyed with the ignorant dopes right now. AHEM.

A lot of admission orders, H&Ps and IV lasix pushes later it was the end of my shift. My knee is complaining and aches a ton, my back hurts from manhandling \/LOC patients around and my head is woozy from lack of blood sugar. I go to my desk. There is a 18 inch stack of pharmacy and clinic papers in the inbox. I punch in my 1234 code to the phone. Robot voice lady tells me "You have, TWEN-tee, NEW, voicemahils."

I bang my head on the desk.

I wake up and I hear "Uhhh, we just found her like this!"

young nurse

I've been a registered nurse for awhile now, which is cool, and I now have experience and continuing education credits and certifications and whatnots, and I know stuff. I've even branched out into three specialties - heart failure, transplant and peripheral arterial disease. That's a lot of stuff to learn.

So, I know stuff, I've done stuff, I've held hands, I've done procedures and a lot of things I could do in my sleep now because I've done them so much. I've worked five days a week for the last three years with tons of overtime and extra weekend conferences and evening training. Things that used to be so hard, terrifying, that would keep me up at night for hours and hours worrying over how to do them or what I would say, now seem totally old hat.

I had clinic today, which is a ridiculous way to follow-up with patients in my opinion, but apparently a long-standing tradition with medical clinics. Basically, patients show up, wait in a waiting room for a long time, for only a 15 minute appointment. A medical assistant takes their weight and blood pressure, sits them in a tiny room where they wait some more. Then a doctor appears (eventually) and may or may not listen to their problem and then scribbles something on a pad of paper for them.

My clinic runs a little different and longer because we are a multi-disciplinary team for severe heart conditions, including a pharmacist and a MD and sometimes other specialist like a surgeon or ARNP, but still, there really isn't enough time during that visit to LISTEN to the patient and do everything and assess everything the patient will need to live the next 3 months of their life and actually know why we are treating and what for and what the plan is. So, the 15 minute appointments are actually 30 minutes or more, so by the end of the day we are like HOURS behind. I've literally had clinic run 3 hours late by the end of the day. Maybe little family practice places where they are seeing sniffly noses can go day to day like that but we certainly don't do well with it.

I was giving a sweet little old patient some outpatient treatment today after their visit (another thing to set me behind) and as I was starting their IV they kept making all these comments like "OH, you did that SO well! Good job!" and just weird comments like that. I finally asked, "Were you a nursing instructor?" because, I don't know, it just seemed that way they were acting a little weird like they were watching a student do something for the first time, cheering them on, whereas I was like thinking "blah blah, IV lasix 80 mg IVP is 8 cc's of...borrring". The patient was like, "well, I am just so proud they are letting high school students into the nursing profession, because I know they are so short on nurses. So it makes sense. I'm proud of you for pursuing a career so early in life."

I kind of chuckled, and was like well I'm feeling kind of flattered that you think I'm so young, and I've actually been working at this facility for three years, and I graduated nursing school when I was 22, but working in the nursing field for 8 years now, but not during high school. The patient said something about how I'm still young and that he was still proud of me, even though I'm not in high school. It was kind of weird.

But made me think, I am glad I have found a career I really love. I'm glad I got out of college on time and am able to just enjoy working and learning. I'm glad I have experience now so that not quite everything terrifies me and keeps me up late at night. I'm totally burnt out already, but my coworkers have all gone through what I'm going through now and are encouraging. I have responsibilities, I get a paycheck, and I get to care for and educate patients and do pretty exciting things. All in all, not a bad gig. And I still can pass for a high schooler to people with glaucoma. Excellent.







ps ..k but seriously, someone needs to invent something besides "clinic" days. i was reading an australian report on heart failure clinics that visited people at their homes.... but figured out that wouldn't work up here with all the rural areas we treat in WA and all the gas money... . i hate clinic.

forgiveness enough

please pardon the horrible grammar/spelling in this very rambly post. i didnt edit.



things have calmed a bit at work. due to hippa law i can't tell you anything about anything, but let's just say certain patients with certain problems were sent to certain specialists to get certain things inserted into their bodies which is always a source of celebration around these parts in organ failure land. whether it be mechanical or from a donor, it gives you a second chance of life and is a controversial miracle. oh how i wish i could share the incredible stories!! and just how happy and awesome it is! and how emotionally draining and yet fulfilling and energizing it is to work as a nurse in this field - all at the same time, weirdness and happiness and despair and laughter, all at once... usually i only have one or two patients like this every few months, this month i had four! all at once! eek!

anyway, today was incredibly uneventful at work, but i realized just how far behind emergent things put you... with non-emergent things. like paperwork. and phone calls to insurance. and phone calls to pharmacies. and phone calls to chronic dz pts. and more paperwork. and charting. oh and more charting. and more fighting with insurance. oh and the staff is super upset and stressed out from last week, so everyone is calling in sick, and the nursing assistants take frequent smoke breaks and are rarely available to their well, uhm, JOB.

it all adds up. just today i had 75 calls on my phone from patients. all little things, requests, questions about results, prognosis, family members, concerns, worries. it seemed every call someone had something kind of bad going on in their life, medical or otherwise - it made me feel small talking to them, offering what reassurance or answers i could. i thought, dude, here i spent the weekend with a bit of a bad cold (stupid summer colds) and feeling sorry for myself and especially pitiful Sunday morning, having a bit (or a two hour long) of an emotional meltdown from all the stress at work of the previous week, the whole "oh i just can't face another week again" deal, and of course it all faded within a few hours and i was myself again (except for the stuffy nose). i hugged my ever-cheerful husband who loves me inspite of the above noted emotional outburst, i also prayed to my Rock and my Salvation who is my Comforter. i remembered all the blessings He has provided, especially all the happy edible reminders out in the garden which shimmer in the sunshine. and i felt small. and humbled. and today again, so small, so humble. For whatever reason, God has blessed me. I do not know why He chose me to bless, i do not deserve it. but He does. and He continues to. talking with all these patients, who have so many, many urgent problems or pain or illness right in their face right now - i just, i have it so easy i think. so so easy.

i heard about this guy that Josh was reading to me about on Saturday night - there was this really sick guy, and his friends and family grew more concerned about his condition, and he was in and out of the hospital, and they took him to every doctor and medical clinic and specialist, and finally his condition grew worse and worse until he was weaker, and weaker, and in pain all the time, and finally he was paralyzed. his mother and father despaired for him, for he had so many dreams and they had so many dreams for him and what he would become. his brothers and friends swore to find him a cure, and they gave their hard earned money and gave of their time searching the country and even overseas for any treatment, anyone who could shed light on the cause of his illness. test after test, treatment after treatment, nothing, it just got worse.

finally, they heard of a religious teacher who had healed people of their illnesses. nothing else had worked - they made the journey to find him. there were throngs of people surrounding the building, it was impossible to get inside, especially with a paralyzed guy. but the brothers would not give up - they dug through a frickin ROOF. Yah, they like, chopped up the roof and put a huge hole in some guy's roof. i dunno if it was because they really had faith in the teacher, that he was really God, or if they were just desperate for answers, for hope - but they did it. Broke probably a bunch of laws like trespassing, destroying property, endangering people who were below them when a roof caved in -- but they didn't care. they were like screw it, my brother needs help. no one else can help him.

when the teacher saw them and the paralyzed guy, he said, "Son, your sins are forgiven."

a hush fell over the crowd - seriously? i mean, that's nice and all, but, isn't this guy's REAL problem kind of obvious? like, hello, he has a serious disease here... he's paralyzed... he's in pain... he is not the person that he should be.

i think i would like to just leave the story here. that it where i left it. for a few minutes at least. you're in pain. you are weak. you are paralyzed now after battling this illness for years and years. you just think, if only i could see God face to face, if he could really see me and know what i am going through, he would heal me. he would change all of this. his whole family prayed for YEARS - years - for his healing and his relief from this disease. they dug through a frickin roof i still can't believe it - and God told the guy "Your sins are forgiven."

now we do know the rest of the story, the guy was healed. but what if we didn't know the rest of the story. what if it was just left at, "your sins are forgiven."

sometimes it is the end of the story. "your sins are forgiven" - is that enough for you?

lappy2000

lappy 2000's diagnoses:

severe osteoporosis
lateral screen-keyboard joint fracture and multiple hairline fractures
diffuse LCD melanomas
rapidly progressing hard drive dementia
complete pacemaker battery failure

nursing plan of care recommendations:

hospice/end of life care
24-hour power supply
excision of memory-eating malignant programs
splint to joint fracture
plan trip to nearest Apple store

best wishes

i do like my job, except i don't, it's a love-hate relationship. i love what i do, i hate all the other extra things i have to do in order to stay there doing what i love to do.

i also enjoy the people i work with for the most part, although some of them i am more like laughing at them rather than with them (coughlindseyv2.0cough). i do have a few cherished friends at work, most who work in random departments far away from my nurses station type places like medical records or procedure rooms where i don't know how we came to be such good friends since our paths rarely cross.

one of those friends left their job in med-recs today to start a new life, a new school, etc. this quiet person who mostly never left med-recs but we all knew to be funny, able to find anything, know everyone, call anywhere, get anything fast. reliable. it was amazing to me that at the "small going away shindig at (local mexican restaurant) after work" had 30 nurses crowded around some tables with margaritas waiting for the guest of honor to arrive tonight. i sat there looking around at those nurses and assistants, who aren't really friends with each other, but all had a story to share about how one person had "made my day so much better!" or "always reliable!" or "so funny!" - and i was amazed. they were all smiling and laughing together waiting for him to arrive. this one person (with one leg, one hand and two crutches) made a huge difference in so many peoples lives. and it takes a lot to touch an old nurse's heart or to get them to go anywhere after a long 5-day workweek is over. they show up to an after work function on a FRIDAY. in their scrubs. and only complained about being tired until the margaritas kicked in.

it was just really amazing. i hope someday i can be a little of what that med-recs kid is to so many.

spring

I've been out enjoying the unusually warm and sunny weather. According to the forecast it's back to the old rain and cold routine tomorrow.

Saturday Josh and I were able to stay out all day at the park and walking around downtown. Sunday we went out to lunch in the sunshine with some new friends.

Today was a punishment to be inside while it was sunny and warm outside. But what was worse is that nothing seemed to go right. I don't think I had a patient get their BP above 70 the whole time. Can we say decompensated! Yes we can!

TGIF

It's Friday!!!!!!!!!!!!!!

Friday, if I'm working in clinic, (Which is where I'm supposed to be seeing people with chronic heart conditions by! the! way!!, like heart failure, angina, vascular disease, etc), it is like I'm a magnet for Walk Ins.

Walk Ins are people who could've called, should've called, but don't. They just decide to drive the 10 minutes or 55 miles to walk into your clinic and demand to be seen for their problem.

These problems are very rarely heart related.
Examples to follow. Not all included.

8:10 AM:
74 year old female. Claims she is having a stroke and NEEDS A NURSE RIGHT NOW. Receptionist freaking out. Talk with the patient over counter in lobby, she drove herself in, she walks to the desk with no limp, she talks in a perfect snobby Connecticut accent, she states she noticed her right eye drooping yesterday. (I do not note any eye drooping.) She saw her family doctor for this yeseterday. He advised something she didn't want to hear. She demands I work her up for a stroke. I told her I didn't have a CT scanner and she would have to go elsewhere. I do a neuro exam anyway just for kicks, completely normal.

8:50 AM:
Male, 40s. Walked in stating he needs his lab results NOW because he feels sick and wants to know if they show any. He did not have labs done at our office. He has not seen a doctor here for a year. He has a cough and runny nose and feels "fatigued".

10:00 AM:
Female, 60s. Complains of extreme, unbearable pain at her cardiac cath entry site (femoral artery). Evaluate, check for bruits, everything I do "HURTS AHH! HURTS!!" Use ultrasound to check for pseudoaneurysm. Nothing there. A small bruise. Oh, the cath was two weeks ago. Oh, after all this, she demands narcotics. Bye bye patient.

12:30 (get called from break room interrupting my sandwich time):
Male, 80s. Demanding to speak with a nurse regarding a "SERIOUS" medication reaction. He feels tired. He has for years. He's been on the same heart medication for 5 years without a dosage change. He is always hypertensive. He is noncompliant. He has decided his heart medication is the cause of all his problems in the whole world. He wants to spend 25 minutes talking about.

2:00 PM:
Female, younger patient, demands receptionist let her speak to her doctor now because she is "very ill". Instead she gets me to triage her. She wants antibiotics because she has a sinus infection. I explain this is why there is a walk in clinic next door or her family doctor. She flips a lid in the lobby for 30 minutes because we won't "take good care of me! you won't!!"

4:00 PM
Male, older patient, having chest pain. Diaphoretic. Cold extremities. Sulken eyes. Shortness of breath at rest. Arm numbness. Ongoing with these symptoms for two days "and it just keeps getting worse". History of stent to LAD, stent to circ, stent to etc. etc. etc. History of small MI prior to stents. Noncompliant with blood thinners and other meds. Immediately start nitro, aspirin and ACS protocol. In cath lab within minutes.
My question for this patient is:
-why not go to ER when you first have the signs of a heart attack?
-how was he NOT dead yet????

4:50 PM (and mind you, clinic ends at 4:00 PM, doors are locked at 5:00 PM):
Pt walks in complaining of a lump in his chest. Sure enough, there is a lump there. I'm not a doctor. The doctors went home or elsewhere. I don't know what the lump is or why it's there. I shake patient's hand, thank him for letting me feel the lump, and send him to the walk in clinic.