Nurse Bananahammock takes a moment

I was saying to the Rickster recently, that I almost wish that I could explain to people that sometimes, just sometimes, when they feel very put out that it has taken an inordinate amount of time for their nurse to get them their requested extra pillow or glass of water or turkey sandwich, that the reason is that the nurse -- I -- was distracted by futilely trying to save a precious little baby whose life was literally shaken out of them.

Here's your pillow.

But, in reality, I don't want to tell anyone about it.  I don't really want to tell the Rickster.  The details are too awful and I wish I didn't have it in my head.  There's no need to force it into someone else's.

Thing is...not only is this now a memory I cannot ever hope to lose, within minutes of furiously working to save a life that was gone before it got to me, and which had just begun, I now have to just move on.  I have to answer the next call light.  Smile at the joke that my patient's husband just told me that I didn't even actually hear.

I'm meant to just clear out the room for the next belly pain or back pain x 1 year and more importantly, I'm meant to give a damn.

I somehow am meant to find some balance between caring and caring JUST ENOUGH that I can then walk away from a baby who has obviously faced constant abuse its entire little life and just casually make small talk with the gal who has an appointment with her GI doc for her IBS, but just.couldn't.wait. till tomorrow.

Because I actually am a human being and I'm not House or Dr. Cox, I can't just make a glib joke and move on about my day.

Sometimes, I just need to take a minute.

Maybe the coolest thing I've ever done

We are, all too briefly, back in NM.  It has flown by but now, today, I got to wrap it up with a wonderful adventure.

I went on a kayak trip that coincided with what is known as "Mass Ascension"  on the first day of the Albuquerque International Balloon Fiesta.

It required me getting up at 4am to be at the kayak tour company.  The email I received from the company was very specific about the time we were to arrive and the importance of arriving on time so that the launch wasn't delayed.

Just as we were about to load up, a large, heavily muscled guy (I'll call him Meathead) said, "I ended up pulling an all-nighter because I knew that I couldn't get up early enough."   Everyone chuckled.  It was a large group, fully booked, but everyone was friendly and we all chatted as we were fitted with life vests and were supplied paddles and then loaded into a couple of vans.

We arrived at the site where the kayaks and canoes were all lined up and the sun was just on the brink of making its appearance.



There, just before we put in, the guides reiterated that the river levels were low and that it was important that we follow their instructions and actually physically follow them because they felt that it was very likely that there would be areas where we'd need to portage.  Luckily, they'd already told us this while we were still at the business site, where I very inexpensively purchased some water shoes.

As the sun began to rise, we were just gently paddling along and then began to see the balloons.






Eventually, the balloons came across the river and some of the more adventurous pilots began to perform what are known as "splash n dash" maneuvers, where they drift down to the Rio Grande and touch the basket down to the water before firing up their burners and taking off again.

The first of those (which was really a landing as they put down on a sand bar, got out, took photos and then took back off) was a German crew. I know this because they spoke German to one another and also, because there was a German flag on the balloon. It was stunning.  And, as we all gathered around to take photos, the guide pointed out the helicopter that was flying above us and said that it was a news chopper and was likely taking video.  I thought that it was far too high to actually get anything on camera, he said, "You'd be surprised."

As it turns out -- we ended up on the news!  Sort of, you can't tell it's us, but I know, because I posted a picture of the balloon that landed on facebook and my friend commented that she'd seen it on the news.  Then she got a screen shot of it for me.





We actually got to witness several splashes n dashes.  As the balloons became fewer and further between, we came to a large sandbar where the fabulous tour company (Quiet Waters Paddling, if you want to have this incredible experience) had us all stop, where they provided coffee/juice/pastries and prepared us for the last leg of the trip which, they said, was the most shallow and the most difficult to navigate.

There were a couple of very shallow spots and, even though I didn't actually have to portage, I did have to get out and move myself off a sandbar, but otherwise, it was actually not so bad.  We fjnally followed a deeper, shallower channel for a while before finally coming to the pull out point.

The group all worked together to help the crew load the kayaks and canoes back up, but before we could leave, the crew noted we were missing 2 people.  At first, they were afraid that they left someone on the water, but they discussed it and knew that they'd had a crew member bringing up the rear and couldn't understand.  So, they counted boats and realized they had all of them accounted for.  They were very confused until someone from another group said that they saw a couple (Meathead and cheerleader) leaving, saying that they were going to call an Uber.

Um...

Apparently, Meathead was heard to say, during our break stop, "Yeah, I'm really tired, I'm ready to go back."

Um...

I allowed myself to be really bothered by Meathead's rudeness and even had a ridiculous exchange of reviews on Quiet Waters' fb site -- not proud of that, though at the time I really just wanted to correct what I felt was an unfair characterization of the trip.

I'm not sure what kind of flaw it is in my character that would let me turn such a great experience into a negative, but I'm going to stop it here.

That kayak trip was, truly, maybe the coolest thing I have ever done and I want to remember only the joy and the beauty and the group camaraderie that were the realities of the day.

I believe you can

I know that somehow, somewhere along the line people stopped teaching their kids this, but...

NEWSFLASH: Life. Isn't. Fair.

And the ONLY way to make everyone equal is to cut down from the top.  If you plant 2 trees and one grows well and one doesn't you can only make them the same size if you cut one back.   Is that "fair" to the tree that grew?

If you need to belittle, demean or insult someone to make yourself feel better, you have not made yourself equal.  You have shown your weakness.

How about instead of giving in to jealousy and anger at those who prosper, you work hard, learn from the successful, don't look at your challenges as a period that brings you to a full stop, but rather a comma that you have to pause and move past?

Humans are capabe of so much more than we think, sometimes.

No matter who you are, I have faith in your ability to do better.

I will choose to help build everyone up rather than cut anyone down.

Every day has a lesson if we're paying attention

I have been making so many notes for blogs that I just haven't had the time to post -- because we are living every minute and enjoying life.

But, I had to post this.

Because this has been such an "aha" moment.

The culture in the ER where I'm working right now is such a great experience.  I am learning new and better ways to deal with problem patients and just generally how to better  keep my cool when something frustrating happens.

They have a saying, "Heart, head, heart" that is meant to remind us that we need to not forget to think of our patients, their families and our coworkers as people with feelings.  It sounds hokey, and there is no shortage of humor about it, ("Is that to tell us where to land the blows?" was the response one day when a nurse reminded a tech not to let themselves be frustrated by a problem family member) but, the staff is actually held to a very high standard of caring and compassion.  For everybody.

They also hold THEMSELVES to a very high standard of medical care.

I am no longer seen as some sort of freak for undressing all my patients.  EVERYBODY undresses all their patients.  Everybody works hard, all the time and the level of teamwork is like no place else I have ever worked (with the possible exception of The Awesome Florida Hospital).

But, the best example of the culture in this ER was when a nurse was trying to call report to the floor right before change of shift.  Somehow, nurses who work on the inpatient units of every hospital I have ever worked, think that patients stop coming to the ED between 6:30 and 7:30 twice a day and we should therefore stop sending patients during those times.  Sometimes, they become unpleasant when they have to take a new patient during those times.

A particular nurse on the floor was very resistant to taking report and proceeded to complain about the continuation of a treatment the patient was undergoing -- a fairly common treatment -- and then was unpleasant to the tech who transported the patient to that unit as well as to the folks in central supply because they needed to resupply that floor with the appropriate equipment.

The ED nurse was very upset when the tech returned and told how nasty the floor nurse had been, in the presence of the patient.

She was planning to file an incident report.  Which would have been completely appropriate.

The next shift I worked, I found out that, instead, the ER nurse filed a commendation in the hospital-wide recognition system and thanked the floor nurse for the teamwork displayed by taking a patient at the change of shift and putting patient care as the priority.

Boom.

Now it's a positive.  And the nurse who was so unpleasant, at least if she has any integrity at all, will now realize how unreasonable and inappropriate her behavior was and will likely modify it the next time she has to take a patient at change of shift, rather than continue to make the ER into the "bad guys".

This is a lesson I will keep with me for the rest of my life.

Westward, Ho! But, first, I need to stop here...and...here...oh, and here...

  As our adventure in Baltimore last summer wrapped up, the Rickster and I were discussing how much we actually sort of dig each other and rather dislike extended time apart.  We, therefore, decided that we needed to find an assignment in a location he was so excited about that he would actually be there with me start to finish.

The Rickster got a gleam in his pale, blue eyes and said, "Man, I'd love to see Seattle."  I popped off an email to my recruiter that I would be interested in going to the Pacific Northwest on my next assignment and forgot all about it.

Fast forward to March.  My recruiter -- who is the truly, most awesomest travel nurse recruiter on the face of the planet -- got in touch, said, "Hey, you said you wanted to go to the PNW this summer.  I have something in Washington state that's already looking, whadda ya say?"  I said, "Go for it".  I did an online and pre-recorded question phone interview (which was odd) and then I got an offer.

In the interim, I had been doing a TON of research and discovered that if my agency housed me, I'd have a long commute (nope).  So, I scoped it out and found housing that was fairly pricey but is corporate housing that has EVERYTHING provided, so I wouldn't even have to bring my travel kit (kitchen supplies, small vacuum, linens, small TV, etc).  So, I demanded a large amount for housing stipend, got almost what I asked for and made other demands related to pay (I really took it in the shorts, money-wise, to work at Hopkins and I wanted to make a decent wage this time).  I got pretty close to everything I asked for.  I was able to guarantee my housing where I wanted it, so I signed (electronically) on the dotted line.

As soon as I signed, I developed short timers' syndrome in a big way and couldn't WAIT to be done with my work at The Awesome Florida Hospital.

I'd planned to have a week or so of no work to get ready for the road and to get the house ready to be left alone for the summer.

That week blasted by.

Then, I made my way west...via Atlanta, Cincinnati and Cleveland.

I am fortunate enough to have friends in all areas of the country and so planned to see as many of them as I could on a completely self-indulgent road trip extravaganza that included coffee roasting, adorable new baby cuddles, and time with wonderful, amazing friends.  Then I spent time with some of my non-crazy family members and got to visit with a life-long friend.

Then, I went to Cleveland to spend some much needed and much anticipated time with My Girls.  You can read about the highlight of that visit on Jimmie's blog here.

I then really did start west, to Tulsa, OK, and got to meet and visit an old online friend from the old Weight Watchers chat boards (which anyone who care knows is where I  met some of my best friends).

But, then, Erica's mom had contacted me about a race for Ovarian Cancer in Denver and a repeat of the team that Erica had originally organized, so I made my way north for that from Tulsa and got to visit with several of the people whom I've grown to love so much.  Sadly, I missed a couple due to their busy lives.  But, there was fun to be had (see post titled "We're from Connecticut").

FINALLY, I headed to New Mexico, the Rickster and our pups.  We had a couple of idyllic, quiet days at El Farolito and then we began our own little Oregon Trail expedition.

And, I can't wait to tell you all about it.

Mothers' Day

My mom did the best she could with what she had in the way of emotion, but we've never had a close relationship, so mother's day has almost always been kind of "meh" for me.

but this woman?  My aunt Jo, was the sister best loved by my Pop and she provided me with that kind of unconditional love, support and occasional kick in the ass that most folks have with their moms.

She's why I moved to Florida when I was 21 and a big old mess. She told me to come here and give myself a chance to make a life for myself away from drama and craziness.  She made me believe I had worth and she was so supportive.  I wish she'd have been around when I made the decision to become a nurse, taking the long road to follow in her footsteps.

Thanks to my cousins for sharing her with me.

Happy Mothers' Day to all the moms and thanks, Aunt Jo.

#JesuisCharlie

I've gotta say this...

freedom of speech is MEANINGLESS unless you sometimes dislike what you hear someone say.

If it's somehow "brave" for someone to become famous for a picture of a crucifix in urine (and no one killed anyone over that, btw) then it does NOT mean that it's ok for someone to kill others because their religious icon had a cartoon drawn about him.

It's not brave to denigrate a religion whose followers are far more likely to just carry a sign or (gasp!) pray for you.  It IS brave to hold a contest for the best Mohammed cartoon knowing that someone may want to kill you because of it.

To say that it is the "fault" of Geller or anyone else involved in that contest that crazy people came to kill them all is no different than saying a drunk girl in a panty-less mini skirt going to a frat party is "asking for it".

The end.

#JeSuisCharlie

I am Dolphin Girl!!!

Full disclosure, this isn't from today, but from a boat tour with Stretch when she was here

I would like this post to reflect the Three Good Things that my friends and I regularly share with one another to help us focus on the fact that even in the worst days, there is always some good.


1. Anna Maria with the Rickster

Ever since the Rickster's brother died from complications of skin cancer (you heard me, skin cancer!) we have been very careful with the Rickster's skin.  He actually has had one episode of "the bad kind" of skin cancer, squamous cell.  Luckily, it was treated and so far (fingers crossed) no more episodes. So, we slathered him with sunblock and had our umbrella and just hung out on the beach.

It started out being pretty sunny, but eventually a haze developed and it became pretty overcast, but it was very warm.  And the water...oh, the water of the Gulf of Mexico is the most beautiful, clear, warm water and today it was ideal.  Very calm, gentle waves.

Unfortunately, we couldn't enjoy reminiscing about the time we were groping one another on the sandbar, early in our relationship while currently groping one another in the gentle surf. We couldn't do that because we ended up having to be sure at least one of us was with our things. A grifter  was obviously watching for people who were intent on frolicking rather than their belongings.  Luckily, I saw her watching our stuff, looking around to see if anyone was watching and then moving toward our stuff.  I yelled, she left, all was well.

While I was swimming at one point, though, there were 3 dolphins who were doing some frolicking of their own nearby.  I tread water and watched them, amazed and --yeah, I won't lie -- a tad scared by how close they were.

We ended our beach adventure by going to the Publix on the Island and getting sandwiches.  We took our sandwiches to the Kingfisher Boat Ramp and found a nice picnic table and had the most amazing conversation while we ate.  These are the conversations that make me so grateful for him.  After more than 2 decades together, we still find each other endlessly interesting and entertaining.


2. Strapping Noodles to my Soul.

I just randomly mentioned to the Rickster a few days ago how I saw someone use pool noodles to strap their kayak to their car, in the absence of roof racks.  Now, my very cool wheels, my Kia Soul, has no roof rack (yet).  So, I usually have to use the Rickster's Sportage. Today?  He surprised me with my very own pool noodles!  And?  It worked!!

3. Today's adventures in kayaking

So, since we went to all that work, I decided to put it to good use and have a sunset kayaking adventure.  There's a place to put into the Manatee River, near the mouth of Tampa Bay just a few blocks away, so I went there and put in.

While it had been very still while we were at the Island, now there was a bit of a breeze, but kayaking was still easy.  I was focused, at first, on getting out of the very shallow area where I put in, but quickly realized there was a pod of at least 4 -- I am NOT making this up -- DOLPHINS!  More dolphins!!  I've seen dolphins in the river there plenty of times, but there was something very cool about seeing them while I was kayaking.  They were oblivious to me.

The reason?  There was this large school of fish that was making an incredible sound...just "whoosh" that was actually similar to the sound the dolphins made as they breached and took a breath.  This school of fish, like a flock of birds, would make sudden shifts in their direction all at once and it was so cool to watch.  For the dolphins, it was meal time.

It was also mealtime for the pelicans.  They seemed to have worked out a tacit deal with the dolphins on taking turns feeding.  But, with food so readily available, the pelicans apparently decided to play.  They kept flying, swooping and then landing.  I swear it seemed as though they landed to watch the dolphins with me.

At some point, one of the pelicans flew close to the water and passed within inches of the front of my kayak.  It then banked and the tips of its wing skimmed the water.  It was such a cool thing to see.  It reminded me of skimming my fingers on the water while the Rickster paddles the canoe.  It was so obvious that he was only doing it because it was fun.

This day.  This day was just magical.

When I told the Rickster, he said that it was just like an acid trip he had at sunrise in Big Sur in the summer of '67,  So, pretty fuckin' cool.

Press Gainey is the death of actual medical care.  

If you think that the satisfaction of patients is the primary determinant of excellent emergency care, you are part of the problem.

Those of us who give emergency medical care actually do care about our patients and do all we can to be kind and compassionate, but if you came to me because you had chest pain, but give me a poor score because the coffee you asked for wasn't hot enough, then none of this makes any sense anymore.

I got into this line of work to save lives of those who are experiencing life threatening medical emergencies.  I have yet to see a bad review from anyone who actually fit that category.

When I read the responses and see "I hate the 0-10 pain score, I couldn't understand it.  Even after they explained it to me, and I'm a reasonably intelligent person."

No.  No you are not. 0=no pain, the number increases with your level of pain.  10 is the worst pain you have ever had in your life.  If you don't understand that, I can't help you.

And yet?  YOU determine if the care I gave was considered appropriate.

What you think of me is none of my business

I work on this every day.


I suck at it, sometimes.  Maybe a lot. But, I keep trying.

Integrity is hard.

But, for me at least, living with the holes in my soul that are created by being false is worse.

Sometimes, I get my feelings hurt (I do TOO have feelings!) and I feel really awkward or left out and I want to say or do things that might make me feel better for a flash, but would probably really hurt someone else.  So, I just keep my mouth shut.

Sometimes, people I really like do/say things that make me uncomfortable.  There are times when it is completely appropriate for me to call them out -- times when I sort of have to.  But, there are times when it sort of isn't my place, so I sit on the sidelines kind of holding my breath, hoping it all comes out ok.

In the end, my goal in life has been (since I was about 13) that I want people to be able to say, "If Mel said it, it's true."  It may have also been wildly inappropriate, but I'm working on that too.  I want to be worthy of the trust of my friends.  I want to be honest with myself, too.

That honesty will include that not everyone will like me.  I'm ok with that.  I'm also ok with others who don't care as much about holes in their souls, those who would say unkind things about me.

Recently, a friend said something to the effect of, "I would just worry about what they're saying behind my back..."

My response was this:

I honestly don't worry much about people who are my friends saying hurtful or damaging things behind my back. I have to believe they wouldn't do that. 

I mean, I'm a realist, I'll bet every (mutual friend in a given group) has been the subject of some private conversation between others in here, dissecting a situation or laughing good humoredly about some thing or other that is only differently weird from them. It doesn't mean they don't still like and even respect each other. 

Sometimes you don't know when people who purport to be your friends say hurtful or damaging things about you and you go on being friends and all is well. Either that means that they spouted off in anger and the person they said it to kept their confidence or it was something they've already pointed out to you was a problem. If it becomes a regular thing for someone to say negative things about me, that will eventually become evident. 

Either way, anything anyone says about me outside my hearing isn't anything I can do anything about. I can only go on trying to be honest and real.

Or, as my good friend is wont to say, "What someone else thinks of me is none of my business."

If you don't like me, and you let that be known, that's ok.  If you don't like me but pretend you do?  That's gonna be ok too, as long as your dishonesty doesn't actually do any harm to me or my reputation.

I'm just gonna plow along and try really hard to be the best version of me I can be.

Anybody? Anybody?

No ranting or political anything in this post.

Actually, it's just an adorable story that was related to me by a new, very cool acquaintance.  And, it's a good reminder to me that those of us in ER should consider the perceptions of other members of the healthcare team.

At a recent party, I met a really smart little Hipster Gal who works in marketing at a hospital where a fellow travel nurse is currently working.  This drew my interest right away because one of my bestest friends, Legs, also works in marketing for a medical group.

Hipster Gal began talking about her younger sister, in her early 20s, who only recently completed her training to be a phlebotomist --y'know, the person who draws your blood.  So, this very young 20-something has very, very limited experience, but was stationed in her hospital's ER  on her first shift.  She ended up in a room with a full on CPR code.  The team had been unable to gain peripheral IV access so they inserted an IO (intraosseous) needle.  This means a very large needle that is forced into the bone (most often in the shin, but more and more in the shoulder) to use the bone marrow as the venue for intravenous medications and fluids.

Now, there are plenty of emergency crew members who don't encounter an IO for quite a while into their first year or even longer.  So, for a kid with no actual medical experience to be thrown into that scene on her first day had to be a bit overwhelming.  Just watching an IO be inserted can be hard.  It's kind of brutal -- but always completely necessary when performed.  It's a last ditch option for administering life saving medications.

Now, while this is all going on, CPR is in progress.  Apparently, as often is the case, after exhausting all treatments, the doctor was ready to call the code, but asked what is almost always asked, in various verbiage,  before declaring death, "Anybody got any objections to calling it?"

This poor kid, seeing this person laying there, exposed, with needles and wires and tubes coming and going, thinks this is a vote.  And, all she can figure is, "If I don't say something, they're going to say this person is dead!"

She was unaware that the person WAS dead.  We don't code living people.  If we are doing CPR, we are attempting to reverse the current state of not alive.

I feel sorry for her that she was thrown so far into the deep end on her first day.  But, it seems she sort of rolled with it and, hey, it can only get easier for her from here.

Continuous Improvement AND Respect for People

I love this blog post.

It explains, perfectly, why I so resent the new rule we have been handed down in my workplace.

Just as this article postulates, as is the case with most folks, if you give me a good reason why I must do things a certain way (ie, urinary catheter prevention, ventilator assisted pneumonia prevention, bedsore prevention, etc) and I am on board.

Give our team input on making things better and the productivity of our department skyrockets (our ER has amazing, trend-setting throughput models that the staff helped to organize).

It demeans educated, skilled people to simply hand down a ridiculous rule with no context, no explanation and no apparently valid reason.

Some background: most all emergency departments use computers on wheels to be mobile, move from room to room and still document in real time.  We use them to scan medications for administration and for collection of all samples as well as documenting care/vital signs/assessments, etc.  Small sidetrack -- we used to call them COWs (computers on wheels). We now call them WOWs (workstations on wheels) swear to Tebow, because someone somewhere thought it could be perceived as insulting to hear them called cows.



Of course, there are not always enough of these to go around, but we need them literally all day, all the time.  So, we tend to pick one, clean it off with antiseptic wipes, log in (we have a quick couple of keys to tap and lock it so that we are HIPAA compliant) and label it by putting our names on a little piece of paper and taping it to the WOW.  This way, it's always available and no one makes off with it without at least saying, "hey, can I borrow your WOW?"

The rule?

We can't put our names on the WOWs.  Why?  It's in violation.  Of what?  A rule.  What rule?  Well, it's a rule.  Whose rule?  Well, maybe Joint Commission.  Really?  Why would Joint Commission care?  What's the reason?  We don't know.  Just don't do it.

Tell me I must do something or not do something "because it's the rule"?  Yeah...you can pretty much figure that I'm going to ignore that rule or find a way around it.  And so will most people.

Legalizing douchebaggery

Dear Everybody:


Legalizing pot doesn't mean you can smoke pot anytime, anywhere you want to.

If your employer has a rule about drugs and you fail a piss test, you can still be fired.  It's no different than alcohol.  You can't show up to work drunk most places, or drink at work, either (Unless you work for an advertising company in the early 60s).

You still cannot drive while under the influence.  Same as alcohol.

Tobacco is legal, but only assholes blow smoke at people or smoke in enclosed areas or right by doorways where nonsmokers can't escape it.

Rights come with responsibilities, folks.  Most folks seem to think they have every right to do whatever they please without considering the responsibilities they have to others when exercising them.

You don't have to live like a refugee

I am sick unto death of victim mentality.

Every single vile thing that a person does cannot be held against them because "you don't know their story".

I don't NEED to know the story of a person who molests a child.  I don't NEED to know the story of a person who holds up a convenience store or steals from their grandmother to support their drug habit or beats their wife.  I don't need to know all the sad woe is me that is the excuse for selling drugs and using little kids to help in that endeavour so that I have to help take care of the ten year old with a bunch of heroin in his pocket after he's been shot multiple times.

Don't care.

Know why?

Well, among other things, because you don't know MY story, either.

Because I don't trot it out as an excuse for every bad decision I ever make.  I take responsibility for my choices.  And, sometimes that's hard because I've made some really bad decisions in my past.

But, if I don't face up to my own responsibility, I will continue to screw up in the same ways over and over.

I was once well on the road to being a sorry excuse for life who whined about my lot in life and the miserable and sundry ways in which I'd been mistreated...then someone did me the favor of telling me that I don't get to use anything that happened as an excuse anymore.

"Starting today, you know that your life from here on will be determined by what you choose."

From that day, even though it wasn't a directly upward trajectory, those words and that mindset helped to frame my life and pull me out of the merry-go-round of bad decisions, the outcome of which became my new excuses.

There are many, many days still when I'd like to point an accusing finger at the things and people in my past that make me more likely to do or be X or Y, but I choose to focus on what is.  What's here in front of me now, in real life.

The result is that, though my life is not perfect, it's closer than I ever thought it could be.

And I haven't turned over control of my life to anyone else.