On Doing That Thing I Do

There was a time in my career when I would walk out of the Emergency department at the end of my shift on top of the world. Actual physical excitement, and I remember thinking on several occasions, 'I can't believe I get to do this job!' I was the luckiest girl in the world. This was all I had ever wanted to do. And now it was here and it was everything I thought it would be and more. Fast forward a few years and the enthusiasm wains. But I've become damn good at what I do. And I'm still proud of what I do. I tell people, I save lives for a living. And it's true. Fast forward a few more years and I'm crying on the way in to work and sitting in the parking garage for ten extra minutes trying to force myself to go it. I get home and can't wait to take my scrubs off. Because I'm so excited to not have to be a nurse anymore that day. I'm tired.

A couple more years. A new state. More sunshine. More freedom. I no longer cry on my way into work. I don't hate my job most days. The fact that this feels like 'success' the fact that I don't loathe my job anymore feels like a win? That's depressing af. I see new nurses and student nurses in the ER and they're so excited. So passionate. And I tell them to hold on to that for as long as they can. They smile because they think I'm joking, but I'm not. I'm not mocking their enthusiasm. I'm giving honest advice.

My uber driver this morning asked me if I liked my job and I told him, "Some days. And some days I wish I'd gone to beauty school." This is not a knock to people who have gone to beauty school. Those who know me know that the people who do my hair are two of my most favorite people, and people that I hold a great deal of respect for. Both for the amazing work that they do and the hard work they've put into their careers, their art. It's something I'd thought about doing once upon a time however briefly, and sometimes I wish I'd done something else. Anything else.  But what I told my uber driver this morning wasn't wrong. I do like my job some days.

I just got home from the Emergency Nurses Association Conference. Three days of classes, mediocre food, and a whole lot of free pens, lunch bags, water bottles, and even a reusable ice pack. I have only been once before. A few years ago in Tampa, FL. The conference is annual, and after the first one I was so rejuvenated and loved it so much that I wanted to go every year. But life happens and work happens and I haven't been since. The thing about the conference is, it kind of feels like church for your job. You go to church on Sunday, you get spiritually fed, and you feel like you can make it another week.

You go to ENA conference and you get your shriveled, blackened, jaded little ER nurse soul revived. You feel like you can go to work another week. Because there is a reason you wanted to do this. That reason gets lost sometimes. twelve years of being yelled at, spit on, verbally abused, threatened, and belittled by patients contribute to that. But that's not the only contributing factor. Even through all that, most of us got into this business because we wanted to help people. We have a skill set and we have the determination to help people even when they're at their worst and most vulnerable. One thank you from a sweet little old grandma can undo a week's worth of abuse from other patients and their families.

The thing that's harder is the 12 years of being understaffed, under appreciated, reprimanded for not checking the right box on a chart, for charting but not scanning the motrin that the 18 month old spit all over your hand. Treated like a petulant child by management and administration. Nurses and doctors are no longer resources. We are commodities. We are disposable operators of the electronic chart robot who exist to click the right boxes so that the hospital can get paid. Oh, and hand out narcotics and turkey sandwiches. So that the hospital can get paid. That's not healthcare. That's not what we signed up for.

And so there's a disconnect. There's conflict. You get tired. And I don't want tired to be my story. Instead of coming to work excited every day to see what I got to do and then leaving feeling like I have the greatest job in the world, I just come to work. Sometimes excited to see my friends. I survive a shift. I fake a smile. I fetch all the turkey sandwiches and narcotics. I do the ordered tests that are unnecessary because it doesn't matter if we as doctors and nurses all think they're medically unnecessary. That's not what we're paid for. We're paid to make sure the hospitals and insurance companies get paid. And to not get sued in the meantime.  Does anyone know the ICD-10 code for holding the hand of the young woman who just got told she had cancer? What about for hugging the 95 year old man who's going home without his wife for the first time in 60 years because she died? What about the ICD-10 code for watching a patient walk in and knowing to put the crash cart outside their room because something isn't right, and you know that just from a glance. Where's that box to click?

What do you do when you 'like' your job 'some days' but you can't imagine what else you'd rather do with your life? I don't have any permanent answers. I can tell you that one thing you do is you go to these conferences. You read books. You watch TED talks. You realize that your issues are not only your's. There are people from across the country, and even Sweeden and The Netherlands who feel the same way. You listen to talks from physicians who feel the same way and have a Facebook following of hundreds of thousands of people who feel the same way. You learn new skills to cope. You get the strength in your ER nurse soul revived, and you get the strength to try again.  And then you go back to work and you take care of the people. You do what you got into this business for. You do it for those people. And you try to check all the boxes to make the desk people happy, but you take care of people for the people. You do what you can. And that's all I have for now. But it's enough.

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.

Sometimes

I love TV. I need TV. It may not be healthy. But sometimes patients die. And sometimes they're young. And sometimes their small children and spouses are in the room when they unexpectedly ...just. Die. And you worry about the child, because... How do you get over something like that? Being a second grader and watching your parent just... And you hear the child tell the social worker as she escorts the child from the room where you and your team of sometimes-superheroes break the child's parent's ribs attempting to coax the heart into beating again, "It's ok. S/he's done this before. S/he always comes back." Because s/he was sick. And s/he'd died before. But sometimes, they don't come back. Sometimes you're not a superhero. Sometimes you just become a face that a traumatized family member recalls when they're haunted by the worst day of their life. And sometimes you have to hit the reset button in your brain because the loved ones of your used-to-be-patient are surrounding them, and singing to them, and being together. And your patient with back pain is at the nurses station demanding to know why it's taking so long to be discharged. And another patient needs medication. And another patient needs labs drawn. And another physician needs assistance for an exam. And another twelve patients are hobbling through the doors. So, sometimes you need to come home, eat chocolate caramel truffles for dinner, turn on the TV, and cry because Will Gardner is dead. And the whole reason you watched the show was to see how he and Alicia would end up together in the end, because surely they would. And you need to cry because he's dead now, and it's sad. And sometimes you need to come home and take yourself to a world where vampires exist. Or where six twenty-somethings figure out life in New York City. Sometimes you need to wish that you were a size two black woman who solves problems for the White House. But today, you need to cry because Will Gardner died, and it's sad. Thanks TV.

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.

Adulthood

Sometimes I feel guilty ...not guilty... sometimes I feel as though at 31 I should be more of a responsible adult. For instance, maybe put the ipad away, stop watching teen-targeted shows, and go to bed when you have to be up in 6 hours. Then I think, ya know what? I spent last night rapidly transfusing massive amounts of blood products in to a gruesome humpty-dumpty who's tongue was sticking out of the middle of what should have been the base of his throat. So there. I can watch you-tube videos and Vampire Diaries reruns as much as I want. And I'm going to eat a popsicle and chocolate covered raisins for dinner. So there!

To clarify... I could sleep, I just don't want to. It's not the gore that is my daily routine that's keeping me awake, rather I use the routine-ness and mundane nature of the gore to justify some questionable decisions. Yay adulthood :)

Note To Self -or Argument to Self...

...In favor of...

Here's the thing. I'm meant to do this. It's in me. It's in every fiber that I am. And it's hard. And it has changed who I am and how I view the world. Sometimes I hate that. That's part of adulthood. No matter your chosen career path, life changes you. And maybe not everyone has to have empathy and show care for the 39-week pregnant mother who was brought in by ambulance after getting in a car accident caused by her drunken-ness. That's what I signed up for. I read a book once before I was even in nursing school. A book written by a travel-nurse and her experiences working in the ER. I don't remember much, but I remember one line in particular. Or I remember the way I heard the line. She said, "You will spend the majority of your time with drug addicts and alcoholics. If that doesn't appeal to you, don't do it." I'm not sure that the idea appealed to me, but it didn't deter me. And if I'm being honest with myself, the prospect was somewhat attractive. This is where all the good cases come from.  And by good I mean the ER version of good.

Sometimes I hate it. Sometimes I cry at the prospect of putting on scrubs and lacing up my running (work) shoes. Sometimes my biggest accomplishment is getting out of my car after that ten minutes in the parking garage and walking into the building. But somewhere deep down in there is the girl that remembers why this is what you wanted to do. Somewhere in there was the girl who dreamed of  "getting a good year or two of medical experience then ending up in the emergency room specializing in trauma. Preferably in a place where it's warm all year, like San Diego." (As written on my graduation-walk info sheet as graduating with my first nursing degree). And maybe the dream doesn't look exactly like what I thought it would when I was 21. Who's dreams do?!  The bones are the same.  

Somewhere deep inside is the girl who signed her work-journal (given by a seasoned RN in order to chronicle and remember the first year of nursing) proudly with a full name and the coveted initials R. N.  The girl who wrote on the first page of that journal, "When I put on my scrubs, stethoscope, shoes, and badge I become more than just a nurse. I make miracles every day. I save people's lives every day. I have the opportunity to bring a smile to someone sad, lighten the burden of a person worn out, and to perhaps leave someone feeling better than they were when I came on shift." And oh the thrill and sense of accomplishment and pride of signing RN after your name.

The girl who got her footing underneath her on a medical unit of a regional hospital and wrote about laughing over hearing 'Mary Had a Little Lamb" in her sleep for a week after having a pt with that song as a bed alarm who got out of bed every ten minutes for twelve hours. Who laughed when the patient started to sing along during hour two --including the BEEP BEEP BEEP of the staff cancelling the alarm. Twelve hours of a ninety-year old woman screaming "MARY HAD A LITTLE LAMB -BEEP BEEP BEEP!"

Somewhere deep inside is the girls who wrote how frustrating it was to attempt to draw blood on a patient. And to be unsuccessful. And to be so unsuccessful so many times. And knowing that girl became the girl that physicians request and nurses would come find when there was a hard stick in Seattle.

The girl that had butterflies in her stomach her first shift in the ER. Who walked out of the hospital on cloud nine for months, unable to believe her good fortune in being able to have such a fantastic job.  The girl who made it through her first two years of nursing in heaven and on track to accomplish all her goals.

It's all there. All the stuff from before. I don't know what it all means, but it's there, and I'm grateful for it. I just can't help but wonder. I don't think I've missed it. I just think... I don't know. I think there's more. There's something new. Something different. I'm not sure how different, but this rodeo isn't over yet!

Truer Words...

Spent more time than usual perusing facebook and instagram and found a few gems too good not to share.  Including this

And this:

But the pinnacle was the following article I found on facebook. I guess technically it was from tumblr written by the husband of a nurse (you can find the original link here), but either way, truer words have never been spoken.

The Reality About Nurses

Written by a husband of a nurse...

Ah, such mysterious wondrous creatures are nurses. What treasures lurk beneath those crisp, white uniforms... What young man doesn't have fantasies of discovering those secrets for himself?

SCREEEEEECH!!!!!!!!!!! Reality check!  I've been married to a nurse for a quarter of a century, and let me tell you, nurses are not what you expect (and I don't even care what you expect, because you are wrong!).  Let's begin by tearing down some of the more famous assumptions about nurses right off the top:

The Nurse as Sex Kitten: Any man who lived through the early seventies or has made it a point to rent such famous videos as "Night Duty Nurses" or "Student Nurses" or "Night Duty Student Nurses" or any one of several dozen nurse-centric skin flicks will immediately believe that all nurses have heaving bosoms, just millimeters away from popping out of skin tight white uniforms. you will also believe that nurses always wear garters, fish-net hose, and stilettos. This, of course, is a handy dress code because movie nurses spend *a lot* of time hopping in and out of patient's beds.

The reality is that most nurses wear scrubs --shapeless, draping hunks of cotton that could cause you to breeze past Pamela Anderson without a second look. Shoes are white and chunky with blobs of things on them better left unexplored. Socks replace white hose and garters, and when is the last time anyone saw a nursing cap? Graduation, perhaps?

The Nurse as an Angel:  If you want to hear the latest gross jokes, just find a nurse. Some uninformed males seem to think of nurses as angelic creatures: demure and loving, a cross between a nun and their mom. Well, hate to bust your bubble guy, but as a group, nurses are some of the rawest folks you'll ever run into. I don't care how sweet and demure they may look on the outside, inside is someone who has seen things that would gag a maggot, break your heart, and drive a normal person nuts. So most nurses develop a very wicked sense of humour squarely lodged in the black-to-sick side of the scale.

Also, in case you are looking for angelic sympathy for the little boo-boo you had in the shop, forget it!! Let's say as a typical male klutz, you manage to saw your finger off. You go running to your nurse wife who is on the phone with a nurse friend of hers. As she continues to talk to her friend, she gives the stub a good eyeballing, slaps a towel on it, takes out a baggie to put the severed digit in, and tells you to get some ice while she is explaining to her friend that her dummy husband just sawed his finger off. As you stand there bleeding profusely for 15 minutes she calmly finished her conversation as though nothing is going on until finally she says, "Well, I guess I better get him to the hospital." She hangs up the phone, looks at you, sighs, and calmly says, "Let's go."  You have just learned an important lesson. On the nurse scale of emergencies, yours is about a minus nine! As my wife has told me, "When you are on a ventilator with six drips running, your head down and your feet up, then you're sick. Anything less than that isn't worth getting excited over."

The Nurses Mutual Benefit Network:  As a male either dating or married to a nurse, you should realize one important thing. There are nurses everywhere.  That, in itself, is no big deal. The fact is, every nurse knows other nurses who know more nurses, so that by the time you are finished, a nurse of the Island Nation of Chuuk who observes you doing something you shouldn't has the immediate capability of getting word to your wife. This system is way more reliable and efficient than the internet and has existed for a much longer time. Take it for granted that your nurse wife will know anything you have done, good or bad, before you get home!

Your Social Life With Nurses:  Nurses hang out with other nurses and soon you may find that all your friends are married to nurses. The reason this happens is because in situations where nurses mingle with non-medical folks things can get ugly. For example, you are out to dinner with your nurse wife, another nurse couple, and two civilian couples. The nurses sit and chat, discussing fun things like bleeding bowels, open sores, how much fat was sucked out of some patient, projectile vomiting, traumatic amputations, etc., all over a nice pasta dinner. The nurses carry on talking as the civilian couples turn funny colors, make faces, and suppress their gag reflexes (and this is if the nurses don't have any really gross things to share like the homeless guy with maggots in his bleeding sores!) After several dinners and gathering like this, you will soon find your circle of friends has shrunk significantly.

The key to avoiding this is to do the following:  Never go out in mixed groups with more than one nurse. A lone nurse is ok. The trouble starts when you have more than one, and when that happens, keep the regular folks away. Also, get used to the idea that some friends and neighbors will take advantage of the fact that your wife is a nurse by calling at all hours of the day and night for advice.  This may include male friends "dropping by" to show your sweetie his rash. The best advice I can give is to just deal with it and hope it isn't contagious.

The Health Ramifications of Being With a Nurse:  Most nurses have been described as having the constitution of horses which isn't true, because I've been around horses and they get sick more often.  The reason for this is pretty simple. After about 3-5 years on the job, nurses have been exposed to so many bugs that they either end up dead of full of every antibody known to mankind. (If you want the ultimate booster shot, just get a blood transfusion from a nurse who's worked in a hospital for 20 years!) You don't have all these antibodies though, so when she does come home with mild sniffles, a week later you're flat on your back with the worst case of the flu in your life!! Oh, and if you are the least bit squeamish, don't even think about the bugs she brings home on her clothes. It will mess with your mind as she talks about her resistant TB patient, the patient full of body lice, or the one with poison ivy in his mouth. So don't ask.

Conclusion: Ah such mysterious wondrous creatures are nurses.

The Things We Leave Behind

Alone, I walk into the resuscitation bay tonight to make sure everything is in order. This is my arena. This is my home, I'm in my element. I breathe it in, mentally preparing myself for the hypothetical next critical case. The patient that had been there earlier in the day had required the use of nearly every piece of equipment, and a large portion of our staff. The cavernous room is chilly and still has an odor... of blood, of sterile equipment, of death. The garbage bins are empty, that's not it. Housekeeping has mopped the floor, that isn't it. The stretcher and surrounding tubes/cords/wires are all spotless. Still though, something in the air.  I clear the monitor and put it on standby, center the stretcher in the room, re-lock the brake, and ensure that the scale on the bed is zero-ed; ready for whatever might get thrown through the doors. A quick check through the drawers in my IV cart reveals that everything is re-stocked, loaded to go the next round. There is a mess of clutter on top. I place the EKG and EMS run-sheet in the medical records basket. The hastily thrown packaging and tape of syringes and needles already used, I throw away. And under it all I am stopped cold by a little small notebook. It isn't big, maybe two inches by three inches, and maybe 40 sheets of small lined paper. The cover is a royal blue and white and is well-worn. There are crease lines from multiple openings and bendings. There should be a cardboard-like back cover, but it is missing. Probably got lost in one of the times it had been pulled out of a pocket and used. I flip quickly through to see if there is anything written in it, and there's a couple random words on maybe two different pages. Written in the elegant script of a generation gone by.  I place it back down and trace my fingers over the cover. I'm deeply saddened by this small companion to a life lost. In my mind the kindly grandfather kept it with him in his shirt pocket for writing things down that were important. Notes of things to be remembered, things to get for his wife while at the store. Something kept near to him at all times. Someone should have this. One of his family members should want to have this, just because it was his. And maybe they do. Maybe they don't even know it existed. But they should want to have it. They're long gone, it's three-thirty in the morning. I can't very well call the grieving family of the man to see if they'd like me to mail it to them, where to mail it, or if someone would like to come pick it up. And really, I couldn't bear it if they said to just toss it out. Someone should want to have it. This little well-worn notebook was important to this man, and it was with him until the end.

I never met him. I didn't participate in his care. But I am so deeply moved by this little book. We can never be sure of what we're leaving behind, can we? I mean, one minute you're enjoying time with family then all of a sudden four hours later a spent crew of emergency-health professionals have exhausted all possible avenues of life saving measure. When all is said and done, when the code is called, when the room is clean, and when the family has all left, what small possessions that were once ever-present will be left in the clutter of left-overs from a grueling resuscitation attempt unsuccessful?  

I pick up the notebook gently once more, turn it over in my hand and involuntarily smile a sad half smile. Rest in peace dear sir. I hope your life was full of everything you ever dreamed it would be.  I place the notebook in a small zip-lock bag with a couple old inhalers. I write the patient's name on it with my sharpie and seal the bag.  I spray a healthy amount of odor-eliminating spray in the room, and take the bag out to the desk, telling the charge nurse that it was left behind. She looks at me quizzically and asks if there was anything in it. "Not really," I shrug, "But someone should want to have it, don't you think? I just feel like someone should want it." She looked at the tidy bag and smiled a knowing smile at me and placed in on her desk.

Frustration Abounds

A conversation I had with the mother of a very sick and very tiny TINY (I guess that should be tiny) baby: (It's worth noting that this is a step above the "Did you have to go to school to do what you do?" question)

Mom: So, how much school did you have to do for this? (As I'm starting a fluid infusion in her infant's tiny IV)
Me: Four years.
Mom: Oh, that's not bad then.
Me: (smile) Uh ...I wouldn't trade it for anything. (She has no idea the HELL that is nursing school. The feeling of constantly drowning. Constant.)
Mom: So did you have to do, like, science and a bunch of stuff?
Me: ...What do you mean...
Mom: You know, like anatomy and biology and stuff, or was it all just nursing stuff?
Me: Well, yeah, there was a good two years of anatomy, microbiology, biology, chemistry, physiology, pathphysiology, all sorts of science just to get into the program. Then there were the nursing classes on top of it. Pharmacology, etc.
Mom: Oh, ok. But then you don't have to remember that anymore because you never use it, right?
Me: (trying SO hard, she's not being degrading, she's quite nice, but WHAT?!) Actually, no, I use every bit of that science every single day in my job.
Mom: (incredulous) Really?!  Wow!

Sigh. It's not her fault. It's not really her that's ignorant, it's society.  Even nurses. I digress. One of the nurses who works in out chest pain-observation unit posted a Christmas card on the announcement board at work wishing all of her coworkers a Merry Christmas. I don't remember the exact saying on the inside. I tried hard to forget, because it is the very thing that irritates me, and it was coming from one of my own!  The gist of the saying was that God had taken two of various body parts (eyes, hands, hearts -probably just one of those) that had various attributes such as caring, soft, sympathy, etc, put them together and called it nurse.  Sigh. A nurse is those things. One-hundred percent. But there was not a single mention of intelligence, skill, knowledge, or things of the sort.

Have you ever tried to search for a quote to highlight these attributes of nursing? I just did. And I couldn't find a single one. Not a serious one. There are all sorts of nursing humor jokes about being nice to your nurse since we keep doctors from killing you. These are funny because they are true. In addition to being kind and caring and compassionate, nurses are intelligent, hard-working, knowledgeable life-saving individuals.

A beloved former coworker of mine, Dr. Graham Walker, put it so much better than I ever could in an article he published in the Emergency Medicine News. Read it --this is why he's a FANTASTIC physician.

I remember thinking to myself and saying aloud to my mother and a few friends that I didn't mean to sound offensive, but I had no IDEA that nurses knew SO much! This was when I was in nursing school. I didn't tell the mother of the infant I was caring for that in fact, the Guinness Book of World Records has named the bachelor's degree in Nursing the most difficult and intellectually challenging of any four-year degree in the world.  And it should be. Think about it. Do you realize that the person who is putting the very small IV in the very small vein of your very small infant is the one caring for your child? Would it not terrify you to think that the person responsible for keeping your child alive did not have an extensive grueling education? That they didn't have extensive training and years of experience? Do you not want -even expect them to be intelligent experts?  I certainly would!

But unless people have gone through nursing school, or been in a situation where a nurse has saved their life or the life of a loved one, how would they know?  The media certainly doesn't paint a picture of this nurse. And I don't think it's their fault, I'm just saying it's not out there.

The terrifying part to me as a health care professional with three college degrees and nine years of emergency experience, is that even as I write this the names and faces of nurses I work with or have worked with in the past are floating through my head. And the faces floating through my head I would not allow to touch a single hair on my nephew's head. I would not trust them to count a single respiration.  Here-in lies part of the problem as well.

Another conversation I had with a coworker last night -regarding another very sick child. I had been asked to get the pediatric resus tray and bring it to a room. If that doesn't get your attention, I don't know what will. I ran to the room with the requested tray and saw a room full of people caring for a very still two-year old child. Still two year-olds are bad. But the nurses and the physicians in the room were fantastic at what we do, and having served my purpose, I left them to do what they do, and returned to caring for my own patients. This conversation was several hours later in the break-room with the nurse who handed off care of the patient just before the resus trays were requested to be on standby outside the room.

Me:  How did that kiddo end up doing? Did he get out of here ok? (he was transferred to a pediatric intensive care unit)
Other RN:  Yeah, he did. He just didn't look that sick at first.
Me: What was his deal?
Other RN: They think it was a bronchiolitis that turned into a bad pneumonia.
Me: Oh. What was his respiratory rate when he first came in?
Other RN: Oh, I don't know. 34 or something unremarkable.

Sigh.  Thirty-four is a normal respiratory rate for a two year old. When I walked into the room with the tray, the child was having oxygen blown near their face, and if he had bronchiolitis and pneumonia and a fever there is no way you can convince me that his respiratory rate was actually 34. It's impossible. I guarantee you it was probably around the 50-60 range. Not good. Here's the problem. Most of us count respiratory rates on the regular adult patient by a 2-second glance and say, oh, it's probably 16. The exceptions to this are ANYONE with a respiratory complaint at all, or a respiratory history, and ANY child. ANY child. EVERY child needs to have their respirations counted for a full minute regardless of what their complaint is. Few people do it. It's wrong. How do we fix it? I've had many conversations with our clinical educator about this (don't get me started on this woman) to no avail. I tell each and every tech I work with that I expect this to be done, and I will make them redo it if I don't think it was done accurately. I also tell them why. I'm the same way with temperatures and appropriately-sized blood pressure cuffs, but that's another post.

I've gotten so very far off track, and honestly most of this blabbering is just for me. I need to get it out, and I get that it doesn't make sense to everyone. I'm just so frustrated!!!  I'm frustrated that I am not respected for the professional that I am in part because of other incompetent nurses. I'm frustrated that I work for a place that keeps hiring people and insufficiently training them. I began my nursing career in a hospital where excellence was expected and anything less was not tolerated. You were expected to come to work and do your job properly and seek out the new and cutting edge technology and information that was at your fingertips. Not every hospital is like this. I learned this while I was travelling. Most of them have been though. And I think we all have a responsibility to make our environment better. I see great opportunity to help here and I just keep running into brick walls. And it's not that I'm the end-all expert in what I do, but I do take great pride in it, and I am good. I could be better, and I strive to become better every hour that I'm at work.  At what point do I throw in the towel and realize that it's not going to work and to put myself back in a situation where excellence is expected, where excellence is the norm? If we can't even fix the deficiencies in our own departments, we can't expect the public to respect the knowledge and skill and experience that we have, because there will always be exceptions. I'm used to working with people like Dr. Walker in the article I linked above. That is the excellence I expect of myself and of each coworker around me. I don't think it's too much to ask when your career is saving people's lives. I don't know what the answer is. I think it should start with the people that are hired, with the people that train them, and for the love of all that is good and holy, sometimes you just need to do people a favor and tell them when it's not working out. Because the ER is not for everyone. And that's the great thing about nursing. There is a perfect spot for every nurse where each one can excel. We're not doing ANYONE any favors by keeping sub-standard employees around of any kind. Sigh.

Remember when I resolved to look for the good in humanity and positive things in my job that could be so easy to loose sight of? Tomorrow is another day I suppose. Sigh.

30 Second Dance Party

This is graphic. Parts will be hard to read. I write it because it's real, and I need to get it out. There are many of you who will understand all too well. Read if you like, I understand if you can't or don't want to. It's okay. Remember a while ago when I talked about the "reset button" after a grueling code in the ER?  This is another of those moments.

There is a patient I had a while back that continues to visit my thoughts on a frequent basis. She was 15 years old. She had been found by a dumpster minimally responsive. She had been left there by a man who had paid for her services and had no further use for her. She was intoxicated and high on several illicit drugs. In the brief time the police officers were on scene they answered three different phone calls from her John inquiring as to when she'd be ready to go out again. She came to the ER alone, unconscious, and cold. Among other life saving treatment, a catheter was used to get a urine sample in order to quickly tell what drugs were in her system. There were over-use injuries noted that are unspeakable. And she was fifteen. And she was drunk and high and homeless and a prostitute and fifteen. Our social worker was put on the task of locating a family member, guardian, or someone responsible for the child. A friend was eventually located who shed some light to the fact that the child had been living this lifestyle for two years, had run away from home, and that her mother was in the same line of employment.  She eventually sobered and warmed up. When she was awake, she wasn't scared. She wasn't upset that she was in the ER alone and hooked up to all sorts of cords and wires. It wasn't her first rodeo. When she was ready to be discharged she was belligerent. And she was fifteen. And there-in lies the true tragedy.

I see hard things. I see people die that shouldn't. I see people be kept alive in ways that I consider tortuous, treated by family members in ways worse than you'd treat a dog. I've saved people that have been stabbed, shot, raped; and I've taken care of people who have not survived these occurrences. I work every day as part of an amazing team, and we've all seen tough things. This one case, more than any I've been a part of stuck with me. It made it really hard for me to go to work for a long time. I kept telling people that I needed to live in a world where 15 year-olds weren't homeless alcoholic strung-out prostitutes. I needed to live in a world where that doesn't exist, where I can blind myself with rose-colored glasses to life's harsh reality.  I thought seriously about finding a new field of nursing to work in. I first thought babies. But I realized when you work in the NICU you sometimes have to deal with parents who don't deserve to be parents, with babies who suffer and will die through no fault of their own. I thought about doing pediatrics, but I know I couldn't handle seeing child abuse cases any more than I already do. I thought about every single avenue of nursing out there, and they all have their downfalls. It was a really bleak way to look at life. But I'm still at it. Still in the emergency department. Do you know why?

Tonight there was a moment on Grey's Anatomy where Meredith was finally able to locate the source of bleeding in a critical patient in surgery. She clamped the blood vessel and asked the interns in the room if anyone knew what to do next. The answer she gave them was "30 second dance party" and there, in the OR, they took 30 seconds to have a little dance party.  That's why I'm still where I am. That's why there's nurses that are still where I am after fifty years. That's why there's nurses that go back to work even after having to carry premature neonates down nine flights of stairs while bagging them during a hurricane-induced power outage and generator failure.  I saw three of those nurses a few days later being interviewed on TV a few days later, and they were asked how they were able to appear so calm in the face of so much chaos. They all three smiled and gave some form of the answer, you do what you have to do. The truth is, that's what we're trained for. That. Is. What. We. Do.

That is why I'm still here. Because of the 30 second dance parties after your septic patient finally has a blood pressure in the 70's. After the pulmonary fibrosis patient is finally able to be intubated on the seventh try because of scarring. After the gun shot wound to the chest and the eviscerated stab wound to the abdomen make it successfully to surgery. After the patient on every medication drip known to pharmacy stabilizes enough to be moved to the ICU. After the patient moves a hand after being given clot-busting medication following a paralyzing stroke. I'm here because of the baby who smiles and blows bubbles at you when they feel better. I'm here for the veteran's thanks for a job well done, when it is I that owe him more thanks than can be expressed. I'm here because sometimes, things go right. And when they do, there is ALWAYS a 30 second happy-dance party. Sometimes physically, but at the very least in my head. I'm here because I'm a member of a team that makes miracles happen. Yes, there are hard days. And there will be many more days, many more patients that will make me question if I have the stamina to do it again. Those patients really do take everything out of you. Everything. But I come back every day, because every day there are victories no matter how small. And no victory is too small for a 30 second dance party.

Mem'ries Light the Corner of my Mind

I remember the night like a crystal clear video playing in my mind, even though it was ten years ago this month. I was driving home in my car Nellie. It was dark, 10 or 11 at night. I stopped at the mailbox down the street from home, got out my mail key, and like any other night, checked the box on the way home. This time there was a white envelope for me in it. A white envelope with a purple Weber State University emblem in the top left corner. I started to shake, grabbed the rest of the contents from the box and sat back down in my car. I took a deep shaky breath, put everything down except that one envelope. I turned it over and with another tremulous breath slid my finger under the flap. I pulled out the tri-fold letter, took another breath, unfolded it as I closed my eyes. I opened my eyes after another deep breath and read the words, "Miss Toni Lehman, the cooperative nursing program at Utah State and Weber State University is proud to welcome you into the class of nursing to begin this fall on the campus of Utah State University." I gasped, grinned, and shrieked in the same moment and clapped my hands and hit Nellie's steering wheel repeatedly in excitement. I drove around the corner and pulled into the driveway. I gathered my belongings out of my car, went inside, put the rest of the mail on the counter and went in to the front-room where my mother was laying on the couch reading a book and having her nightly bowl of popcorn. I turned the corner, grinned, and proudly proclaimed, "Mom... I got in!!" Then I jumped up and down, gave her a big hug and then sat down almost in shock on the piano bench. I had done it. I was one of the top 24 of the 325 applicants to one of the nation's top nursing programs --and I made it into the program on my first try. I remember the moment so well now, the moment that shaped my destiny and has taken me on such a crazy journey. It's crazy to think and more than just a little surreal to reflect on where my life is now because of that one night. It's just so right. Everything before and every tear and moment of laughter since has brought me to this place where I am in my life now, and it's just... So. Right. What a crazy road, this thing we call life. Can't wait to see what else lies in store!

The Little Things

As I'm ready to leave work for the night, I discharge my last patient; a 2 year old with step throat and a fever. Earlier in his visit we had tortured the poor kid by looking in his ears, gagging him with a strep culture, making his eyes water and nose burn with a flu swab, and finally by holding him down and plugging his nose to force him to swallow medicine to help him feel better. He was really on to something when he said "no" as soon as we walked in the room. And he broke my heart when he cried "please stop" during the flu swab. Through the power of a popsicle all was forgiven, and as he left, he turned around, said thank you, and blew me a kiss. And that my friends is why I love my job. Sweet blown kisses and thank-yous from cute kiddos who feel better -who clearly have stellar parents. I needed that reminder today. It really is the little things :)

My Legal Experience

So... I just survived my first meeting with prosecuting and defense attorneys. SCARY!! Although not as bad as I was anticipating.  I just kept hearing the reassuring words of a co-worker of mine over and over in my head, "Just remember you're the expert witness. You're the expert."  Thanks to Meghan for the reassuring reminder :) One of the side-effects if you will of my job, being a witness on legal cases that we see. In this instance the alleged incestual rape of a 17 year old girl I took care of a couple years ago. (Yeah, a couple years! Thank goodness for good charting!!) And ...might I say ...there are some fine looking people walking around the county prosecutor's office!  Glad I dressed up!

Good day...

Today was one of those days at work where I'm just so grateful for the job that I have. One of those days that reminds me why I wanted to do this ...ya know as opposed to the days when you have shit thrown at your head (figuratively ...and literally unfortunately) you're called every name at the book and yelled at by every ungrateful patient and their ungrateful family members. Don't get me wrong, I (and my coworkers) laugh at most of the names we are called, and roll our eyes at the impatience and sheer ignorance of our ...more challenging patients. But every once in a while you get a few morsels of gratitude and experiences that make all the crap worthwhile.

I had been at work for about three hours and was BORED out of my mind. As was the charge nurse, the nurse working in the zone with me, and one of my good friends who was in our zone chatting. We were actually bored enough that we tried our hardest to tempt fate by repeatedly vocalizing how bored we were and how quiet it was. Usually a sure recipe for disaster. It didn't work. For a long time. But then the medic phone rang :) We all grinned and waited to see what it was going to be ...hoping for something truly gruesome or super sick and actively dying. Turns out it was an 86yo gal with a sudden onset of abdominal pain, who had passed out and had a blood pressure in the 40s. And no IV access :) Woohoo!!! Twisted I know :) The medics had tried multiple times in her arms, and twice to get a central line in her neck and couldn't find anything. Without getting too far into the medical details of it all, the patient likely had a ruptured hole in the aorta in her abdomen ...she was loosing lots of blood really really really fast. So me and my three bored friends prepare to converge on this actively dying patient. Within minutes of her rolling through our doors, I had thrown a 14g in her left arm, and another nurse had thrown an 18g in her right. The medics who were still giving report on the patient looked at us stunned, each took a dollar out of their wallets and handed them to us. A 14g is big. Like really big. Like almost ball-point pen (the metal and ink-holder part) big. And an 18 is big too. But more importantly, the patient was in the OR having her ruptured AAA repaired within 57 minutes of hitting the department. We even got to use the rapid transfuser ...that's always a good time :)

A few hours later after we were all bored again, although not quite as bored as before, triage brought me a patient. I already had three and there were several nurses with only one or two patients. I didn't mind, because I like to be busy, but it was just a little strange. The triage nurse that brought the patient back came up to me and said, "Toni, I brought you a patient because you are the best." I laughed and he said, "No. seriously, I was thinking about where to put this kid and I thought that if my kid was this sick you would be the first person I'd pick to take care of it." And he was SERIOUS!!! And we had some pretty rockstar nurses on shift. I detest febrile child workups. I don't mind doing them if the kid is actually sick, but more often than not we get roped into torturing them because of the numbers. But this time I was glad to do it ...what can I say, I'm easily manipulated ...flattery will get you everywhere :)

Anyways, that's it :) I love my job and I love my coworkers!!

Switching Gears

In my travels I've had the opportunity to meet many wonderful and amazing people. One of my all time favorites is a friend named Graham, pictured above at my farewell to NYC party. Graham Walker, ER resident extraordinaire ;) He was a 2nd year intern at St. Luke's in Manhattan where I worked two summer's/fall ago. Amazing person, amazing friend, amazing physician. And extremely great with words. You can follow his words blogs and general information here, here, or here. Oh, and did I mention, he's brilliant? In particular today I am reminiscing about a 'note' he wrote and published to his Facebook account almost 2 years ago today. It was entitled 'Reboot' and you can find the link here. The words are as follows.

"I'm always amazed at how much the ED can just keep going after some code or major trauma or absolute train wreck. Not just at how we physicians can mentally re-orient ourselves: 'Current task over, return to other patients now,' but the entire department. The housekeepers keep housekeeping, the nurses keep nursing, the techs keep teching; the controlled chaos returns after a sudden eruption of hell breaking loose.

"This is especially true and eerie after a death. Someone utters, 'Time of death eleven thirty-seven,' and it's like you've just rebooted our minds. We return from whence we came, doing what we did before, but now maybe a little sadder, a little more downtrodden, and a lot more behind. We whisper something to ourselves, pausing for a few seconds to grieve, and keep moving. Try to save the next one.

"A couple hours later, the body has been packaged and removed and the room is completely cleaned. Fresh. A new patient sits in the gurney, dangling his legs off the edge of the bed, wondering when he's going to be seen. He has no idea what just went on two hours ago in the exact same place. You briefly make eye contact as you walk past the room. Ignorance is bliss.

"The room is back to how it always is, with nothing left but your memories of what just happened. How you broke the poor woman's ribs at 100 beats per minute. Crunch, crunch, crunch, crunch, crunch. How you stuck sharp things in her mottled, edematous frame. How before all this, you stuck the tube in her throat and figured things would start turning around once you controlled that airway. And then an hour later, how you ran through your differential one more time, everyone straining their brains as if there's some obvious procedure or drug or incantation you must just be forgetting that instantly resurrects the dead:
What?
Am?
I?
Missing?
You sigh. And then you call it.
'Time of death, eleven thirty-seven'
Reboot"

I love this. There are many things that you just have to experience to truly understand. The way that the workers in the ER are like the closest of close-knit families. But I think that even if you don't really get the 'reboot' post in the same way us ER peeps might, you get the gist. Last night at work after coding a patient intermittently for 2 hours and starting him on every drip known to man, the code was called. The doppler had been used to attempt to hear any discernible traces of remaining pulses in the soon-to-be deceased man. The ultrasound is brought in to confirm that there are no remaining traces of cardiac activity. The code is called. Reboot. New patients are waiting. As are those that were waiting while we were breaking ribs and drawing blood and pushing fluids and medications.

So I went to see my new patients. Medications were ordered on a patient 18 weeks pregnant who had urticaria of pregnancy. As were fetal heart tones. I grabbed the doppler, taking a moment to appreciate the irony of what the machine was last used for. I wheeled it into the room, gooped on the cold cold jelly and placed the doppler to the patients pregnant abdomen and heard a solid rapid thump thump thump thump thump. Humming along at a healthy 148 beats per minute. I left it there several moments longer than necessary. I love listening to fetal heart tones. I just think it's amazing. To hear a happy healthy baby's heartbeat while it is in an innocent blissful place doing nothing but growing fat and happy to make it's debut into the world. And it was especially reassuring at that moment. The circle of life and all that. The very machine I had used not ten minutes earlier to confirm the death of one man, was at that moment confirming the healthy fetal life of another. Reboot indeed. Life goes on. I have the greatest job in the entire world!

My Girls

Last night I was driving to work when Shania Twain's 'Any Man Of Mine' came on the radio. I literally laughed out loud. And of course I totally rocked out to the song. I had flashbacks to oh-so-many nursing school road trips with my best nursing school gals karaoke-ing away to Shania and Christina Aguillara and Billy Currington. Oh, Billy. So this is a quick shout out to my best nsg school friends (and still among my best of friends today). Together we survived the worst hell possible. We made it through all the wondering if we were ever going to actually get our heads above water, all the marathon study sessions in the library, the bachelor parties, the road trips, and a few bathroom incidents... ;) Love you girls! Together we learned how to be the amazing nurses that we are today ...6 years later. (Wow, we're getting old ;) ) (I couldn't find any pictures of us IN nsg school on my computer, so the first one is the year after we graduated... the second one was 5 years later -- last fall at Melissa's wedding)

Last night...

...I assisted on a pelvic exam where a surprise foreign body was found. The PA-C placed the foreign body on the exam table covered in copious amounts of foul smelling green and yellow pus. The patient looked at it, the PA and I looked at each other trying to hold in our giggles. The patient says to the PA, "WHAT is that?!" To which the PA replied, "You tell me." The patient looked at the purulent slimy coated foreign body and said, "Oh my gosh! I haven't seen that for months!!" It wasn't a tampon.

I found a used condom --not of the medical kind while cleaning a room that a patient had just been discharged from.

I saw a very elaborate and detailed --and very large --phallic drawing, in pen, covering a patient's entire back.

I had a patient with such a massive intercerebellar bleed that her tonsills were herniating down her throat.

I had a patient that we diagnosed with a giant left temporal mass. She became went from a completely independent active life to completely non-verbal in 2 hours.

I took care of a 8 month old in severe respiratory distress, and several other patients in between.

And this was all in the last 8 hours of my shift. I spent the first 6 hours in triage hating people for not understanding that Emergency Rooms are for LIFE THREATENING emergencies. And now, I'm going to bed. Goodnight.

Public Service Announcement

It's that magical time of year again. Flu-shot season. As a preemptive strike, I figured I'd get all my pet peeves out there to begin with. First of all, I apologize to whoever it was I was making fun of the other day for complaining that their arm ached after their flu shot. I got mine yesterday and my arm does indeed ache a bit today. So, whoever you were --I honestly don't remember --I'm sorry. Now on to the matter at hand.

You absolutely positively in no way can NOT NOT NOT get the flu from the flu shot. I assure you that it is physiologically impossible. We ask every patient who comes in the ER doors if they were vaccinated for the current or most recent flu season (thanks joint commission). I swear 90% of the people tell me that they get the flu from the flu shot. For the most part, I just bite my lip. Picking my battles if you will. As I said it is physiologically impossible. It canNOT happen. There is NO exception. I think part of the confusion comes from my second pet peeve on this topic.

The flu shot is not to prevent the stomach flu. It is to prevent influenza, the respiratory virus. Some people to get the unfortunate side effects of nausea with a possible bout of vomiting with the flu shot. This is not influenza. And quite honestly, throwing up and being nauseated for a day is much better than a week long bout of influenza where you cough up a lung, can't breath out your nose, drain rain gutters out of your sinuses, run fevers of over 101, and every muscle in your body --including ones you didn't know you had --aches.

I understand that not everyone will get flu shots, and that's ok. But at least know why you're not getting one. If you don't want it, don't think you'll get the flu (the influenza NOT stomach variety --again, just to be clear) or just don't believe in vaccinations, that's ok. But at least be educated about what the purpose actually is.

One more thing, because I foresee it being an issue. You can still get influenza if you just get the H1N1 vaccine. And you can still get H1N1 flu if you just get the normal flu shot, although your chances are less. And for the love of all that is good and holy, do NOT wear masks!!! And wash your freaking hands! Wash your hands, sneeze into your elbow, not your hand, don't rub your eyes or your nose. Simple hygiene is the best way to prevent yourself from getting sick. From the flu and other colds coughs etc. One final tip --NyQuil. Best drug ever.

So Long Old Friend

The good old days of TV Thursdays are officially over. When I was 12, I began to be a faithful watcher of TV Thursday. Each week I watched Friends and ER. I watched Friends faithfully to the last episode with my family or friends. The last episode of Friends was when I was 21. I essentially grew up with that show. I mean, those were some pretty formative years. There is not a single episode that I have not seen at least twice, and some that I have seen more times than I can count. There is a Friends situation for every moment in life.

ER was after Friends every week. For the 10 years Friends was on the air I did not miss an episode of ER either. Friends and ER every week. In High School my best friend Kristy and I would watch ER together every week --even if we were at our own individual houses and watching it together over the phone. We would claim it was to study for our Medical Anatomy and Physiology class. I had known that I wanted to be a nurse ever since I was in kindergarten. But Carol Hathaway and the show ER is what let me know that I was going to work in the Emergency Department, and I was going to love it. So it is somewhat ironic that I had to DVR the finale of ER tonight, because I had to attend my own real-life version. The show that inspired me to the career and profession that I love is over, and I will have to watch the finale when I get home from doing what the show inspired me to do. Thanks for the good times ER :)