Thursday, September 25, 2008


For quite a few years now my friends and I have joked about how Disney ruined our lives. As little girls, we grow up expecting to be magically changed into a beautiful princess in a ball gown, or swooped in on and rescued by prince charming, or woken from a curse by true loves first kiss. We think that we can turn slimy forgs and mean scary beasts into dashing and charming princes. We grow up believing in happily ever after. Reality realization can be rough, but you get over it and joke about how Disney ruined your life, because you now have all these unrealistic expectations. I've been thinking about unrealistic expectations and fairy tales, and about how glad I am that I haven't gotten what I thought I wanted in some things, but in others I still yearn with everything I am to get my way. So when I sat down to watch Grey's Anatomy tonight, these were the thoughts that were running through my subconscious. How come I know that what the Lord has in store for me is better than anything I think I may want, but that doesn't stop me from wanting to give it all up for what I want right now? I think it's because a part of me is still holding on to the fairy tale. Damn Disney. We still believe in spite of everything that happily ever after does exist and that we can have everything we want without sacrifice and trials.

Well, ironically, tonight's episode of Grey's Anatomy was all about happily ever after, and how maybe it's not so great after all. I'm reminded of a 'You might be a redneck if...' joke by Jeff Foxworthy, where he said, "If an episode of Walker, Texas Ranger changed your life might be a red neck." Grey's and Walker aren't the same thing, right? :) Anyway, so I'm watching Grey's and within the first three minutes I have a new favorite quote. Meredith who is narrating says, "Happily ever after doesn't exist. And the first guy who said it did should have his ass kicked SO hard!" I laughed out loud to myself, then texted a couple of friends, because I knew they would appreciate it. It's what we've always joked about --only funnier. Happily ever after doesn't exist, and I still maintain that it's NOT better to have loved and lost than to have never loved at all. (see previous blog entry :) )

The episode went on to propose the idea that, maybe it's ok that happily ever after doesn't exist, and maybe ...just maybe, reality is even better than the fairy tale. Reality is darker, stormier, and scarier ...and maybe better. Is that possible?

I am a perfectionist. I like to do things perfectly. I don't like to do things, especially in front of others, that I don't feel I can do well. I hate loathe and despise making mistakes and messing up. I'm sure you're all getting sick of me saying the words 'in my profession' but you're going to continue to hear them :) At work, this is a great attitude, because it makes me efficient and careful. If I mess up at work, people die. Literally. So I don't mess up. If a waitress messes up at work, people are angry because their food will take longer, but it is easily remedied by a price deduction, free dessert, etc. There is no remedy for errors in my line of work. My perfectionism applies to other things as well though. Just ask my sister or Josh, both of whom have tried to teach me to drive a stick-shift car. In all reality, if I had to, I could drive from point a to point b in a standard car. I know how to do it. If I had my own car, and no other options, I could drive it to an empty parking lot somewhere by myself and practice until I could do it flawlessly. I'm ok with this. By myself in my own car I can mess up all I want until I can do it perfectly --without risking someone elses expensive new car. But if anyone else is in the car to see me make a mistake, all bets are off. I have never stalled the car with either Josh or Heidi (both of whom had to do some serious talking and/or bribing to get me to even sit in the drivers seat of their cars) but I occasionally don't make the smoothest of transitions between gears. Without over or understating, the car might lurch a tiny bit once with every other gear shift, nothing more than that. But it's not perfect, so for me it's not good enough. Unrealistic expectations --maybe, but that's life. This is just one example of many. This attitude extends to literally every aspect of my life. The way I look, the way I dress, the way I shop, finding my way around town without getting lost, paying bills, cleaning, laundry, painting my toenails --everything. Why do we force ourselves to live in whatever fairy tales our brain creates for us? Because we're led to believe that the fairytale is the ideal. That the fairytale is the pinnacle of happiness. It's a very frilly fluffy pink warm and fuzzy idea. This should have been my first clue. I am not a fan of frilly fluffy pink warm and fuzzy.

My perfectionism is an example of me living in another kind of fairy tale. No matter how much I or others try to convince myself otherwise, I have to believe that I can, should, and have to be perfect, and do things perfectly. Anything that I cannot do perfectly is not worth doing --therefore I don't. Like when you were little and your parents used to say 'anything worth doing is worth doing right.' This is my own extreme version of that.

Now let's talk reality. In reality, people die. Literally. People make mistakes. They drive after drinking and kill other people. Or they kill other people for no reason at all. People smoke and kill themselves. People get their hearts broken, people fall down. People get hurt. People get lied to, betrayed, cheated on, spit on, abused, and taken advantage of. Reality kind of sucks. In reality people make mistakes. It is by making mistakes that we learn. It is by making mistakes that we grow. In another episode of Grey's there was a patient that had a disease where her tissue was slowly ossifying --turning to bone. She had a daughter who in a lot of ways reminded me of myself. She was a perfectionist, holding on to the mistaken idea that if she and everyone around her did and planned everything perfectly, that happily ever after would appear like a magic wand out of the sky and make everything ok. Alex tells her the following --and it's one of my all-time favorite quotes, "You have a healthy body. If you fall you won't turn to stone ...let yourself fall. Messing up, it's what makes a person, it's how we learn, it's where we find joy --in the things you don't plan for, things you never see coming." It is by making mistakes that we let ourselves grow, and it is often when we are at the bottom of the barrel that we are truly at our best. Does that make sense?

So in reality, we fall in love and some of us get our hearts broken into a million pieces for one reason or another. I don't have mine entirely back yet, and I honestly never will. I left a piece of it in Seattle, and reality is, that that's ok. It was part of my experience, and the things I gained from that, and the things I learned and loved about being in love are with me now, and will be forever. There will always be a hole in my heart --sometimes bigger than others, but it's ok that it's there. It's who I am, and that's ok.

In reality, you make mistakes, you get your heart broken, you can't get over things that wyou know you should have gotten over long ago. But in reality you have friends who don't complain (at least out loud ;) ) when you call them crying --still. They tell you that they love you and that it will be ok. They tell you that you're not crazy for wanting the things you want, or for grieving over things you're grieving over. And they help you through, over, and/or around your self-imposed stumbling blocks. They give you permission to accept the death of a relationship or ideal or other form of fairytale. They even let you have a little funeral party (thanks Jill :) ) to allow yourself time to grieve. In reality you fall, but friends catch you. They remind you that the reality of your life, and the life that our Father in Heaven has in store for you is better than any fairytale you could dream up, and to not accept or dream of any less than you deserve. Don't doubt what you deserve, and don't dream of less that what you deserve. They tell you that not only should you be doing better, but that you CAN do better, and WILL do better.

This is turning into a jumbled weave of a bunch of different types of fairy tales, and I'm not meaning to be so unclear. But I am talking about all of them, seperately and at the same time. Maybe I do mean to be unclear :) Romantic ones, perfectionist ones, professional ones, any fairytale that you may be holding onto for yourself. We all have them, and they're different for each of us. But as narrating Meredith said near the end of Grey's Anatomy tonight, "Reality is so much more interesting than the fairytale!" I think she may be right.

In closing (lol ...I don't know why that sounded funny to me just now :) ) I tend to get into a funk with music. I will pick a song that is the theme for my life and listen to it repeatedly for it's therapeutic value. Occasionally I will post the song on my blog, but not always. I changed my blog theme today to a song that has been my theme since I came to New York. Tattoo, by Jordin Sparks. When the song first came out, it irritated me that they played it so much so I boycotted the song. Then one day when I was feeling sad about the way I was leaving Josh, I heard the song and heard the words for the first time, and I love them! To me it is about him, but also about other things that have changed my life. I think it applies to a lot more that romantic relationships. We are changed forever by our experiences, and at least a small part of them will always be with us and influence the way we are and do things. And it's ok. That's who we are. Here's a link to the lyrics ...check it out. I really like them!

and now, because I feel the need to post pictures with all of my posts if possible, here are some pics of my best friends and family ...Love you all --and may the reality that is better than all of our fairy tales come true!!!! And, ps ...this is the first time in a long time I've been able to say his name out loud in relation to the relationship without it tearing me up inside --well type his name, but ya know what I mean :) I'm growing --yay :)

Monday, September 22, 2008

A Bittersweet Day

I have wrote and re-wrote this post so many times I've lost count. The fact is, it can't be done. It can't end. Yankee Stadium will live on forever in the hearts and memories of millions who have walked through it's hallowed walls. The place is larger than life. I could spend hours telling you about the rich history, the storied pomp, and character of the best venue in sports history, but those who would really get it don't need me to tell you, and those who don't already know won't gain anything from me trying to explain. It's one of those things that simply has to be experienced. You don't need to know the history of this place to feel the vibration ad electricity run under your feet when you're at a game. You don't need to know the intricacies of the legends who roamed the field here to feel their presence. You might not have known that's what you were feeling, but those who have experienced it know that there is nothing like it in the world. It isn't something that can be explained or quantified. The great cathedral of baseball, the house that Ruth built, Yankee Stadium has hosted it's last baseball game. There is a beautiful new stadium going up across the street that is waiting with open arms to welcome new records and new legends to be made. The spirit of the fans will still be there, and the pride power and pinstriped tradition will still be there. I like to think that before April 16th of next year, you will be able to hear the cleats of the ghosts of Yankee Stadium as they cross the street to make a new hallowed ground out of the new Stadium. Old record books are closed and new ones are ready and waiting to be written upon. No matter where the Yankees call home --be it the north or south side of 161st & River Ave in the Bronx, the spirit that makes the Yankees will follow. You can take the Yanks out of the old stadium, but you can't take the spirit of the old stadium out of the Yanks. The Yankees are pinstripes and perfection wherever they hang their hats. Many memories were made here, and I have many memories that I saw myself while here, my own favorite memories of the stadium that I will keep with me forever, as do countless others. So thank you to the Yankees -past and present. Thank you to the Steinbrenners, and thank you to the fellow fans who have made this place what it is. There was a sign hung over the rafters at the final game last night that said it perfect. Yankee Stadium --the House that became a Home.

Tuesday, September 16, 2008

Welcome to the Jungle

I usually try to not give to many specifics on funny stuff that happens at work ...ya know, privacy laws and all that, but I can't not share my night last night. So there I was. Sitting at the desk staring at my computer screen in disbelief and dread wondering how many more people we could pack in to the ER. We had 56 patients, and 8 of them were mine. And it was only 2100. Time for our usual nightly rush. So I stared at the screen full of patients simultaneously organizing the 14 things that had to be done in the next 5 minutes and willing the computer to make the patients stop coming. What did the computer do in response? It popped up with an emergent patient for me to take care of. Emergent patient classification is saved for a very few time critical conditions, and the nurse is required to make an assessment in 20 minutes. I like to make one in less than 2 because these patients are massive traumas or respiratory distress or in the middle of a massive heart attack or stroke. So I glared in vain at the computer, and ran to the patients room trying to will the triage status to yellow instead of red before I got there. Well, it didn't happen. And it got worse. The patients room was one of 2 pelvic rooms reserved for pelvic-land problems. This could only mean one thing. My patient was in labor.

I am NOT a labor and delivery nurse. I hate taking care of whiny pregnant women, and the littler the baby is the scarier it is. The problem is that no one at the hospital is a labor and delivery nurse. The hospital does not have a labor and delivery floor. Labor and delivery and women's center is at the sister hospital downtown. We do occasionally get the pregnant gal who has not had prenatal care or who is new or visiting the area and has not been instructed to go to Roosevelt Hospital if you think you're in labor. We stabilize these patients and quickly send them in an ambulance downtown. So I open the door to my patients room, she takes one look at me and screams, "I CAN'T DO THIS!!!!!!" at the top of her lungs, her eyes wide as saucers. I silence the groan building inside my throat, and successfully stop the rolling of my eyes.

I have not ever had a child. I have not ever been in labor. I have not ever been pregnant. So some might say that I have no room to talk, but you would not believe the number of people we get screaming and writhing in agony as described above and they are dilated to maybe a 1 or 2. As in 8 or 9 centimeters of screaming to go. I'm sure it's painful. But come on! The uber painful part isn't supposed to happen until around 7 centimeters. Besides, falling off a 10 story building is also very painful I'm sure. These patients never scream and writhe in agony. They can't. We sedate and paralyze them and shove a tube down their throat in the interest of keeping them alive. You can't do this to a pregnant lady. Unfortunately for me. This is why I am a trauma nurse :)

So, back to my screaming out of control patient:

Me: "Hi! My name is Toni, and I get to be your nurse tonight. How long have you been having contractions?"

SG (screaming gal): says nothing, holds her breath, her face scrunched up and turning a brilliant shade of red.

Me: "Ma'am, you're going to need to breathe. Take a big deep breath. There that's it. Now, next time a contraction comes, I want you to breathe through the pain. I want you to take big deep breaths in, then blow the pain away as though you were blowing out candles on a cake." (Where did that come from? I don't say shit like that, I must remember more from nursing school than I thought.) "Now, is the contraction gone?"

She says that she thinks so. She tells me that she has been having cramps for the last two hours. She has not seen a doctor at all for her pregnancy. This is getting better all the time. She doesn't remember her last period, but thinks it was in December. The last time she had sex was on New Years Eve when she was raped. Fantastic. Poor girl. She wants nothing to do with the baby. Understandable. Some lucky couple was about to have all their dreams come true because this baby will be placed for adoption. She does not want to see it or hold it or touch it when it comes out. She denies any alcohol or drug use during pregnancy. This means nothing to me. They all do. So what I have here is a 25 year old girl who is who-knows-how-far pregnant, but appears to be full term, who has no idea if her baby has a heartbeat, or an enclosed GI tract, or any one of a myriad of things that can go wrong in pregnancy --add to it the possibility of drugs and fetal alcohol syndrome, ad I've got a nightmare. A screaming, dilating, breath-holding nightmare.

I leave the room to go find the doc who signed up for the case. By some small miracle the attending had picked up the case. Yay! Maybe God didn't hate me so bad after all. I mean, at least I didn't have to deal with a baby doc (what we call the residents, interns, and students --lovingly of course ;) ). So I give Ashley the rundown on the patient and get stuff to start an IV and draw labs while she goes to see the patient. I get the IV started and hook the patient up to the archaic toco monitor that we have. This is the monitor that watches baby's heart rate and mom's contractions, and the correlation between the two. I dust off the cobwebs in the far corners of my mind and remember not only how to apply the pads, but vaguely what a monitor strip should look like. The baby does indeed have a healthy heart rate. The contractions are every 2 minutes and last for 30 seconds. Yikes.

While all this is going on, I am continually having to remind my patient to breathe in and out, and she is constantly screaming at me that SHE CAN'T DO THIS!!! I use my best acting patient and kind and all pink warm and fuzzy like a labor and delivery nurse would, and say, "But honey, you ARE doing it! You are doing great! I'll be here with you the whole time." I think I just threw up in my mouth a little bit, but it seems to have calmed her somewhat. By this time the Ob/Gyn resident has arrived and is ready to check the patient. Ob residents aren't bad. They tend to be scared of us ER folks. I suppose we can be intimidating, and quite honestly, I understand how we get our bitchy reputation, but that's a whole other post. So this guy comes in the room, looks at me with look of relief that there is another female in the room and shyly asks if I would possibly have a moment to chaperon as he does his exam. I grin and say, "Sure." My grin is bigger inside my head.

That is until he looks up at me in horror mid exam. "Well," he says, turning to my patient and thoughtfully removing the look of horror on his face for her benefit, and continues with the words that make me choke on the breath I was taking, "You're ten centimeters." I look at him using all my telekinesis to make him take it back. Surely he's not serious. Instead of taking it back he says, "I'm going to go page the attending at Roosevelt, and have him come up. We'll work on transferring you, but chances are, you're going to have to deliver here." "Your MOM is going to have to deliver here," the voice inside my head says. I don't think I said it out loud. So he goes out to page his attending, I turn with a smile frozen in disbelief, and look at my patient. She jumps off the bed and screams --again, at the top of her lungs, "I'm going to SHIT myself!!!" I fight the urge to giggle, then remember that this is a sign of imminent delivery. It happens when the baby is crowning, and I think to myself, "Me too!". Instead of saying this out loud, I make her lay back on the bed, I run to the doorway and scream at the top of my lungs down the hall in hopes that the charge nurse or someone will hear me, "I need the OB and a delivery kit STAT --she's CROWNING!!!"

I turn from the doorway back to my patient in time to see the baby's head peeking out. Oh shit! Then she lets out an even louder scream than before --I didn't think this was possible, turns out I was wrong --as the babies shoulders wriggle free and the rest of it's tiny body squirts out into my hands on the bed. Her screaming stops, and she resumes breathing, her head turned toward the wall and covered with a sheet so she doesn't have to see the baby. The baby isn't crying. Babies don't cry until you cut the umbilical cord. They don't need to until you clamp the cord. I don't have anything to cut the cord with. I don't have anything to clamp the cord with either. So in true ER nurse fashion I improvise with what I have. I pinch the umbilical cord with my fingers and the beautiful baby boy lets out the most beautiful cry i have ever heard. He was breathing and he was pink and he was perfect! 10 fingers and 10 toes.

With that obstacle cleared, my mind was free to further evaluate the situation at hand. I am holding the umbilical cord of a newborn baby between my fingers so the baby can live, in a room with a lady who just gave birth and wants nothing to do with the beautiful baby that is in front of me, in a back corner room where apparently no one can hear me scream. I only have two hands, and one is occupied keeping the baby alive by pinching the umbilical cord. The other hand should be drying the baby off to keep him warm, I remember that was important in nursing school. Unfortunately, I don't have any towels to dry the baby off with. Nor do I have towels to dry the baby off with or wrap it up in or clean up the very large pool of blood and post-baby goo that my patient is now laying in. Ew. Again in true ER fashion, I improvised. I reached across the bed to the small pile of clean gowns on the shelf above the bed, and pulled a few down. I used the clean gowns to start drying off the baby, and ask my patient if she is doing ok. I tell her that she did a great job. It's true. She did. She pushed an over 8 pound kid out with NO medication whatsoever. Strong work! She sighs happily, and says "Yes, I'm doing fine."

At this moment the OB resident comes back in with a delivery kit, whistling as he slowly saunters in. "You're late," I say. I was stating the obvious, but I don't think my voice was as venomous as I intended it to be. He looked at me in shock that turned to disbelief as he looked at the little boy in my hands and the not-so-pregnant-anymore girl laying happily --and quietly --in the bed. He went into a flurry of activity, throwing the delivery kit on the bed, and started mumbling half orders. "Ok. It's fine. We need ...clamp ...scisso --ooh, we need to dry ...and a warm ... ...wait! Is he breathing?" "DOCTOR!!!" I snip at him, perhaps a bit louder than I needed to. "Yes the baby is breathing, that's the small screaming noise you hear. It's fine, just breathe." You can't make this stuff up, maybe all residents are the same after all. I felt like I was in the middle of a tv show. This should not be happening. The baby doc recovered, and clamped the cord freeing both my hands to finish drying the baby and wrapping it in the blankets that came in the delivery pack.

As we transferred mom and then baby to Roosevelt, she thanked me profusely and told me that I had been wonderful. I smiled genuinely and told her to take care. I hope everything starts looking up for her. She seemed like a great girl now that she wasn't screaming in my face. And the baby was just cute. All was well with him and we eventually transferred him to the nursery at Roosevelt. I walked out of the now empty room that looked like a war zone, and there was suddenly a plethora of people as I walked back to the nurses station --patients waiting for x-rays, my coworkers, and security guards who all told me good job and congratulations. I was pretty proud of myself. I had survived. No time to revel in my glory though, I still had 8 patients who with various complaints --all of whom I was sure needed something. I was ok with the fact that they all still had airways.

This is a really really long post, but I have to tell you about the other thing that happened last night. It's worth it, I promise :) Read on...

So there we were. It was 0445 and we were finally slowing down. We had slowed down enough that most of us were sitting around chatting, waiting for lab and radiology results to come back. One of the nurses was trying to discharge a homeless patient. This is always a challenge. If we have the room, we will let them stay in a stretcher somewhere and sleep for the night, but in the morning, we have to let them go. None of them want to go, and they put up varying degrees of a fight when you tell them they have to. Sometimes we even have to have security escort them out. The patient this nurse was trying to discharge was particularly difficult. He has even spent time recently in prison for assaulting health care workers. The nurse came back unsuccessful but unscathed, and we sent in another nurse and the resident to try again a few minutes later. We were all peering around the corner from the desk, ready to jump in if needed. The guy reaches for his bag and starts digging and sifting through the piles of whatever was in there. We immediately waved security over and the nurse and baby doc backed away. We were all expecting him to pull out some semblance of a weapon. Security was stopped short when the guy pulls a baby raccoon out of his bag and THROWS it across the room at the doctor. Then gathered his belongings and ran away. Meanwhile, 5 security guards are chasing a frightened and frantic baby raccoon around the department, while the resident stood motionless in shock, and the rest of us burst into uncontrollable laughter. It was the funniest thing I've ever seen in my life. Who keeps a baby raccoon buried under layers of garbage in a giant duffel bag? Where does one get a baby raccoon? Why does one feel the need to store said baby raccoon and use it as a weapon? Again, you can't make this stuff up! I love my job! Good times. Well, now I'm exhausted, so I'm going to bed. I get to go back to the jungle tonight. I can't wait. :)

Wednesday, September 10, 2008

To the writers of Grey's Anatomy:

My sincere apologies. All these years, well, at least the last four of them, I have rolled my eyes while watching your show. I have scoffed at the idea of surgeons running codes in the ER and doctors starting IVs, foleys, ng tubes, and drawing their own blood. Turns out in some large teaching hospitals all these things actually happen.

That's right folks, I still have to start IVs and draw blood and start foleys and ng tubes, but now it's only when the residents can't get it. At first it was oddly refreshing to not have to do these things, but the novelty has quickly worn off. Residents tend to be idiots! There are a few who are pretty decent, but by and large --idiots! Pretty much what we as nurses at the large teaching trauma center I work at is what we know is going to be the end result that the docs want and wait for them to get there. For example, a patient will come in with a complaint, say chest pain, and we will quickly start the lines before the residents can blow them all, and draw the labs we know they're eventually going to want. Even thought when we ask them, they say, 'no we don't need that.' So we draw them and keep them labeled in our pockets and wait for them to change their minds and order the tests. Every once in a while it is fun to be smarter than the baby-docs, but for the most part, it gets old pretty fast.

That having been said, I love my job! I work at the level one trauma center for northern Manhattan, Harlem, and the southern Bronx. Not nearly as active of a knife and gun club as I would have hoped, but I suppose that's a good thing. The people I work with are great, and you really can't beat living in the city. It really is the greatest city in the world. Only in NY can you walk from the most affluent privileged neighborhoods in the world to the poorest of the country's ghettos in less than two minutes. There are have's here and there are have not's. But there is also a large working, middle class population. There is also a large immigrant population that are living the American dream. They are the people that have the light and glimmer of a hope for a better future for their family and work every day to live their dream. It is an amazing thing! Honestly, it's strange when I walk down the street and hear someone speak English! Then again, since labor day ended all the tourists are Europeans. That's a different story though :)

Anywho, not much else going on, but I'll leave you with a few pics of my new "locale" :)

My hospital --two buildings --the ER is the first floor of the building on the right.

Grant's Tomb in Riverside Park

My favorite spot in Riverside Park

Church is the brown brick building to the left of the white one. The chapel is on the 4th floor :)

Me in Central Park

Me in a canoe in Central Park --by far the coolest thing I've done in the city!

I'm rowing!

View from the fire escape night of the hurricane!

View of Manhattan from Brooklyn with the 9-11 tribute lights

Me and 2 of New York's bravest in my apt building :)