Time

Time is a funny thing. There is something in it's passing that takes away the negatives. At least for me. And I suppose this is a blessing. There are certain times in your life when you just reflect back and say, "You know what? That was really pretty cool. And I'm really proud that I was a part of that." And it's not that I don't see the good while I'm in the moment, because I do. I really do. I see the good. I feel the good. But there's this fierce part of me that is never satisfied with less than perfection. That chooses to focus on the flaws and the things that can be improved. This is both a blessing and a curse. I'm a generally positive person --or at least I was before working so closely to the general public... haha. Honestly though, it's not that I focus on the things that could go better to be negative, because I really do see the whole picture. I see the positive. But in the heat of the moment the deep rooted part of me that strives for perfection always and in all things points out all the things that need to be fixed. Things to make better. Things to improve upon for next time. Because as smoothly as things can appear to run there is always room for improvement. And I think that my brain picks these out in this continuous struggle to attain the unachievable perfection.

As time wheels away, round and around the memories go while the bumpy rocks and sharp divots get chipped off and smoothed over so what is left is a smooth round whole view of the situation as it was. And looking at the new smooth round memory reminds me to be more present. Accept things more as they come, in the moment. Perfection isn't a thing. As much as my stomach churns at the thought. It isn't. Perfection isn't real. The passing of the time doesn't make you forget the struggles and tears. But it does however put them in perspective. And what you're left with is a pretty damn good life.

I've done a lot in my 32 years. And I've been a part of some pretty damn amazing things. And I've complained about them. And I've struggled through them, and I've cried. A lot. Here's the thing though, perfection isn't real. The word "but" is grossly over-used. Things in life are rarely mutually exclusive. The last year was a rough one for me. It was such an interesting struggle. Because it was at once the most amazing slice of happiness -being closer to my family and being able to see my nephews grow up- and the worst year of my life. At the same time. Nothing has ever felt so fundamentally wrong on every level, and I fought it. because it also was amazing being so close to my family. And there were good things, there always are. So what now? What if being in the same state as your family is just absolutely not what you're supposed to do? What happens if the second you get in the car to drive away a two-ton weight is instantly lifted from your chest? I don't have answers. What I do have is a free and light feeling that whatever this is, it's right. And that's enough for now.

But time is a funny thing. Because when I saw this video that a former coworker made of the last year at Intermountain Medical Center what I saw was that we were pretty damn amazing. And we did and they do AMAZING things. And I'm so glad and so proud that I got to be a part of it. I don't see the collective hours I spent crying while having to put on my scrubs, and sitting in my car in the parking garage convincing myself to go inside. I don't feel the feelings of ...not fitting in. I don't remember the times I was astounded at the stupidity and narrow-mindedness. I remember that I worked for a world-class trauma center and that we saved lives. And that We. Were. Amazing. And I miss these people. We weren't perfect, but we were good.

Wisdom and A Longing for Home

I just took part in a research study on wisdom in nursing practice, and I'm feeling overwhelmed. After the week I've had I needed today. I needed to realize as I talked to the researcher that I AM good at what I do. That there is truly a lot of actual wisdom that goes in to what I do every day. I am not a trained monkey who fetches pills. Being good at what I do takes so much more than education and training. It takes a solid base of knowledge and education that is put into a continual loop of experience in stressful situations, debriefing, and adding what you learn from each situation where you make a difference to your base of knowledge, and the cycle repeats. As I spoke with the researcher about stressful situations where I feel like I made a difference I was homesick for my Seattle Family. In each scenario we discussed I was bursting with pride for the team I was a part of, I was proud to tell her the way that we made a difference, and in the way that we practiced excellence every day. There was such a thirst for knowledge in my Valley Family. The desire to know more, to be the best, and to continually learn was truly truly remarkable. And I miss it. It was one of the forests I didn't see for the trees when I was there. The raw intelligence coupled with the desire to learn and grow and do and be the best at all times is not commonplace. It should be, but that environment, those people, were truly unique. I have been fortunate to work with many great great healthcare professionals. And each place I've worked has had a handful of greats. Valley just has a lot more than a handful. The network of people there are nothing short of amazing. The team, the family. There's not another place like it in the world. The doctors, the nurses, the techs, every piece was the embodiment of what healthcare should be.

Preach it Sista! --A Must-Read

I came across this blog post and the following reply linked on facebook by two of my friends and former co-workers in New York. It is too good not to share. I can't tell you how tired I get of hearing people complain about how long they had to wait in the ER that one time when they had to go. A former patient of mine said it best on a particularly horrendous night at Mission Hospital in Mission Viejo, CA. He had just been assigned to a room, I came in and apologized for the wait. His reply has stuck with me for six years. He said, "You know, I never feel bad about having to wait anymore because there was one time I didn't have to wait. I brought my five year old son in who was not breathing. We were rushed back and immediately surrounded by a team of nurses, physicians, and techs. My son is alive because of those people, and I hope I never have to not wait again. Every time I have to wait, I thank God." Emergencies don't wait. That's what it boils down to. Remember that before you call your local ER to inquire what the wait time is. We will NEVER be able to answer that question because we can't see you over the phone. Hint: if the wait time or weather has any effect on your "need" to go to the emergency room, it's not an emergency. Rest assured, if you have an emergency you will not wait. It is called an emergency room, not a convenience room. That's my ten-years-experience two cents on the following article and reply. The blog post was written by and ER nurse and the follwing reply was written by a man who has been an ER physician for fifteen years.

Someone named Rose replied to the original blog post with her opinion that being busy is no excuse. An opinion that seems to be popular among those who have never seen the inner workings of the emergency room --be it as a healthcare worker or emergent patient. The following is the reply of Derek, an ER physician --priceless:

December 25, 2013 at 7:55 am

Rose, you must have accidentally thought you went to the “Convenience Room”. Believe it or not, you actually went to the “Emergency Room”. In theory, there should not be a single test performed in the ‘Emergency Room’ that we can just ‘send you home and call you later’. We are testing for, well, “emergencies”.

Can you imagine: Ring, ring… “Hey, Rose? … Dr. Smith here. … Yeah, so the tests came back. … You are, in fact, dying. Rather quickly, actually. … What?. … I know, right?! … Yeah, so, an-tee-way, do you mind, like, coming back in?… Great!…. Also, please stop by Arby’s and have a double roast beef and supersize curly fries before you come back. Thanks! Drive careful! … Of course you can have a work note. See ya in a bit! We’ll get the Demerol ready!”

The reason you are waiting so long is people have lost sight of what the emergency room is about. ED staff are overwhelmed with noise and trying to pick out that signal in the noise is becoming even more difficult. That includes PMD’s, specialists, nurses and especially patients.

Seriously, last shift I worked these were some of the chief complaints: ‘vomited once 3 hours ago’ … ‘no complaint- car accident yesterday, wants to get checked out’ …. ‘no complaint- had positive pregnancy test at home and wants to confirm’…. ‘bloody nose in a 13yo *yesterday*; mom read on internet it could be cancer; wants cancer testing’- at 3am …. ‘rash for 2 weeks, called PMD answering service at 2am, Told patient to go to ED’

The reason we ignore you is the same reason you turn the radio down when you are following directions. We need to concentrate so we don’t get lost. I say this about 10 times a shift, “If you are waiting in an emergency room it is a good thing.” You don’t want to be the person that doesn’t wait. Trust me.

The average stay for an ED visit is 4 hours. *Average*. So half of all ED visits will be over 4 hours.

God forbid you call your primary, wait 1 or 2 weeks and then to go to your primary, then wait another 2 weeks for results. Honestly, your problem will most likely be resolved before you get to the appointment. You can then cancel your appointment then BAM! Money in the pocket.

50-70% of what comes through the door does not even need to be there. Remember the Great Runny Nose Epidemic of 1746 that killed 17 million people? Exactly, because it didn’t f’ing exist. Colds just go away after 2 weeks. So does most everything else.

Also, when did fever in otherwise well appearing children become an emergency? And vomiting? Geez, when I was a kid I didn’t even wake up my parents. I would just get a trash can and vomit all night. By the next day gone.

Wait, you don’t have a primary? If only they could invent something, like a book that would have phone numbers in it– we could call it a “phone **book**”. We could even separate businesses from regular people. Perhaps, a different color of paper, like green, red… no! How about yellow?

Wait, you have no money? How can you then possibly justify a $1500 ED bill for cold like symptoms vs a $300 office visit? Don’t forget the $700 ambulance since you couldn’t find a ride.

BTW, No, I will not give you a work note; i need you to go to work and pay off your *&%$-ing bill so everyone else doesn’t have to pay double on account of your lazy ass.

Also, don’t tell me you don’t have $300, when you spend $2098.76 a year on cigarettes. What? Oh, you just bum them off of everyone else and don’t ever buy them? Ah, Just like your healthcare.

ED doc for 15yrs.