Yikes

I don’t even want to look at the date of my last post. Thankfully, Orthogals is still going strong, and strong enough that Ancient Faith Blogs picked us up! Woohoo!

Where have I been instead of online self-publishing? Well, you know about this:

Which lead to this:

And during that time I worked nights:

Around the time I got to switch to days, we found out this was coming:

Props to my 6-year-old niece for thinking of this all by herself!

And in late October, she came!

Sigh. I hadn’t even finished changing my legal name on my accounts…

For the time being, I plan on keeping up TRS. I’m blogging about different things now, but then again, this wasn’t supposed to be a one subject blog. It’s my thoughts and ponderings on life, and those have changed a lot too.

One Day at a Time

I’m a new nurse.

I have to keep reminding myself of this. I’m new. I’m going to make mistakes.

Thankfully, none of my mistakes have resulted in adverse patient reactions. I haven’t overdosed anyone on their narcotic pain medication. If my assessment found an abnormality or something new, I reported it.

But I’ve been late on timed lab draws. I didn’t get a “Keep Vein Open” order with a patient controlled analgesia (PCA). I charted something on a patient, only to realize after signing that it was the wrong patient. And I’ve certainly handled a few interactions with less grace and clinical judgment than I would like.

I hate making mistakes; I hate knowing that I’ve failed or been under par. I worry that I will never get this nursing thing figured out. It’s these days that I cry.

But after a day or two off, I pull myself back together. Double check my care plan, make my list, and set out to improve one patient at a time.

And then I come home. And I’m new to marriage as well. We’re both new spouses. We’re going to make mistakes.

Some days, he’s helpful and a wonderful shoulder to cry on when work goes horribly wrong. Other days, he doesn’t see that I’m tired and asks for my help with tasks that, in my opinion, he should be able to figure out by himself so that I can sleep. There have been times where we are both oblivious to the ways we hurt each other. And then when the courage is mustered up to say, “____ really hurt,” it isn’t met with the response wanted but with more fuel for the fire.

Then the time comes where we say, “I’m sorry. Forgive me,” and keep working on this one day at a time.

Moms

I am not a mother.

Yet, last night at a baby shower, I had a wonderful time chatting with mothers of all sorts. I still feel new to my church community, even though I’ve been attending faithfully since moving about two years ago. I love how the community is adjusting to the changes – they celebrate births, baptisms, marriages, chrismations. And they mourn together and help when someone of the community has a physical or spiritual need.

I am so thankful for the opportunity last night to talk with those moms and women of my community.

I started the evening talking with a mom adjusting to her high school freshman daughter. She’s asking herself, “How do I help her find her way, but let her do it?” She recognizes the talents, brains, and abilities and is excited to see how her daughter will use them. But is also wondering how to let go and give her daughter room.

Mom B is lively with three college-age and beyond kids. One is planning a wedding, one seriously dating, and one still trying to figure out life.

Mom C has 3 children under the age of 8. Her baby has multiple food allergies, and since she’s nursing, she has to cut those foods out. Her other two are a lively handful and she’s homeschooling. She was so vulnerable in sharing that some of the negative behaviors she sees in her children, she knows they got from her. Thus, to have her children change and nurture their spirit, she has to change.

Mom D was the guest of honor and will be a new mom after only one year of marriage. I’ve loved getting to know her these months; she’s so chill and relaxed with the perfect amount of sarcasm.

In this period of my life where I’m engaged and preparing for marriage and the possibility of motherhood, I am always struck with how open these and other women have been with their lives. I’m honored that they want to know me and my struggles in this time as well.  Some have shared the worst parts of their engagements and marriages with me. They shared their children’s delights and joy; they shared their struggles, fears, and what is at the heart of their prayers. This is not as a “WARNING: RUN NOW!” but rather an encouragement to build the good foundation and habits in my marriage and (eventual) parenting.

I guess this is a “fluffy” post where I can pinpoint the exact “meaning” of my experience. It’s amazing how going through drastic changes in my life allows people to feel confident in sharing their joyful and difficult experiences. And maybe that is the “glue” of a community.

Dating a Seminarian

I entered a new frontier the past summer – I’m “in a relationship.” But as this requires as much adjustment and introspection as being single, don’t think that my blog has suddenly lost its purpose.

Yep, you heard me, being single – a content single – requires as much introspection and processing as dating someone.

Anyway, my boyfriend is an Orthodox Seminary graduate. With my involvement over at Orthogals, it was suggested that I write an advice feature on dating a seminarian. Since this would involve his life, I ran the idea past him. The conversation:

Me: So, the Orthogals are wondering if I can write a feature on dating a seminarian. What do you think?
Him: Um, I don’t think that’s a good idea.
Me: (seeing his reticence and suddenly being aware of the personal nature of it) On second thought, maybe not.
Him: Actually, let me give you my advice for dating a seminarian – DON’T.
Me: Yeah, if people actually look at the demands life will have on that family, they wouldn’t seek it out.

Later, I was chatting with my priest about life and how mine was shaping up. In hearing that my relationship involved a seminarian, my priest offered his wife as a resource to me. Of note, Preoteasa is the Romanian equivalent to the Arabic Khouria and Russian Matushka – all are terms of respect for the priest’s wife. In my parish, it has been abbreviated to “P’sa.” The conversation as follows:

Me: Your husband volunteered you as a source of advice for me.
P’sa: Oh? For what?
Me: Dating a seminarian.
P’sa: Run. Run FAR away. 

So, ladies, there you have it from both the potential priest and the wife of one – don’t seek out that position and enter with caution if you do get called.

 

When The End Comes

Sorry that I’ve been absent for so long. There has been so much to juggle the past few months, and since I have a few people with whom I can verbally process my life, I guess blogging hasn’t been a top priority. I have plans to fill in some of my thoughts and experiences from the summer, but they will have to wait.

The reason for this entry, however, is that last night I received word from Stewie that The Brain finished his battle/war with ALS.

While I hate that a terrible disease has taken yet another person in such a cruel way, my emotion is not so much based on anger or depression or bitterness. I am actually relieved to know that he fought his battle in the only way he could and was able to let go. I am relieved to know that Stewie will have the opportunity to sleep through the night for the first time in over 2 years. I am relieved to know that The Brain was able to let go of this life and not give up hope.

I’m sure there will be more writings and musings of my grieving. But they will be dampened as I do not feel my life will make as much of an adjustment compared with others.

I have been struck the past few months in how complete the prayers of Orthodoxy are for the human experience. When we let go of our pride that says only extemporaneous or spontaneous prayers are best, we find a vast wealth of wisdom. So, I leave you with several of the prayers available in the Orthodox Prayer Book published by Holy Protection Monastery in Colorado (aka “The Blue Romanian Prayer Book”)

Oh good Lord, remember Your servant(s) _______ and forgive them all in which they have transgressed in their lives, for only You are without sin and can grant rest to the departed. In Your divine wisdom and love for mankind, You bestow all things and provide for all the needs of man. O Creator, rest the souls of Your servants _____ who have placed their hope in You, O Lord, the Fashioner, the Creator and our God. Amont the saints, O Christ, rest the souls of Your servants where there is neither pain nor grief nor sighing, but life everlasting.

In one of my conversations with The Brain before I left for nursing school, he expressed to me his fear of being forgotten after his death. So, I now can pray the words I reassured to him that day: Memory eternal.

 

To The Babies I Held on My Birthday

Obstetrics clinical rotations began this past week. Day 2 was Wednesday, July 17 – my 31st birthday. Here’s what I was thinking that day.

Dear Little Ones,

Welcome to the outside world. The past week was filled with a lot of change for you. You are still dependent on your mother for nutrition and warmth, but you are now breathing on your own. And this time it’s air, not amniotic fluid. Your heart and lungs have gone through intense change and you are still causing your mom hormone and physical changes in this post-partum period. Your dad, while not new to this, is still in awe and thankful that the both of you are safe.

You didn’t know it and probably never will, but I took care of you on my birthday. 31 years ago, I was the new bundle of joy. I’ve seen pictures but time fades colors in the pre-digital photography era. I have to wonder if my face looked like a model for a porcelain doll and if my lips were perfect cherry red as yours are. As I held you, I didn’t mourn that I have yet to push a new human out of my abdomen. I was overwhelmed with a distinct sense of hope for you and wonder.

What delights will you bring your parents? How will you and that big brother I saw earlier get along? Will you color on the walls or play in the mud? Will you break hearts or have your heart broken? What will you be so passionate about that could help your corner of the world?

I hope sincerely that you will not disappoint others, but you are human, therefore you will. Thus, I hope more that you learn to ask for forgiveness and extend it. I hope you are able to see Truth and want it for you and others.

As I hear the news of what the world is throwing us – the suffering isn’t new but you are. May your eyes be opened gently so you don’t see too much at once, yet just enough that you are able to have compassion and help as you can.

It is wonderful to look upon you just being you. Content that your needs are met.

Thank you for that gift of seeing life simply when it is complex. My only regret is that I can’t tell you this for when you’ll remember nor can I leave your parents a note – that would just be creepy.

May the Lord have mercy on you daily.

Your Student Nurse

And in case you, the reader, are wondering, here’s from 31 years ago:

When The End is Near

The past two weeks The Brain has been in rapid decline. I am thankful I was able to see him over Memorial Day when an hour-long conversation did not take all his energy for the day. Besides, since last Thanksgiving, I try to do most of the talking. He has recently consented to swapping out his usual king-sized mattress for a hospital bed and does not balk at any medication interventions to control secretions or pain. From what I read in updates, he is not uncomfortable but there is a huge battle with peripheral edema that refuses to go down. Edema, or swelling, is a sign that the kidneys are not motivated to keep filtering the extra water and usual waste products out of the body.

We talked about ALS our last day of lecture in Med-Surg 2 along with other “chronic neurological disorders.” I had to work hard to not dominate the discussion. The question was posed to the class, “What do you tell a patient who asks you if there is a cure for ALS?”

Under my breath I muttered, “You tell them to plan their last vacation.”

When going over some of the collaborative care for ALS, a group recommended Physical Therapy along with some other options. I spoke up and said that physical therapy is good, but the patient is not going to improve over time. Rather, massage therapy might be better as it had been beneficial for The Brain. Unused muscles cramp up and become rigid; if the patient will allow a massage therapist to work with the muscles early on, the later neuropathy due to muscle atrophy is greatly reduced. Having helped multiple people move or even roll in bed, those with loose muscles are MUCH easier than those with rigid and spastic muscles.

As I said earlier, hospice nursing is different. You know that your patient will not beat their disease or win the battle with their body. I knew when I first started working for The Brain and Stewie that there would be an end; I just didn’t know if I would be working for them when it came.

My prayer has not changed nor has my view of reality to the situation. Reality is merely coming into focus more clearly, along with the true reality that we are all given the gift of our lives, and we get to share those with others. I am continually thankful for Stewie and The Brain sharing theirs with me, even as ALS is sneaking around the back for its last hurrah.

Thus, as always, Lord have mercy.

Patient Simulations: Medical Student Edition

From: http://www.zazzle.com/funny+nurse+postcards

Thanks to technology, student in medicine, nursing, and other patient care roles can be put thought simulations with patient mannequins. “Mission control” is behind a two-way mirror and can “talk” for the patient, monitors are “connected” to give real-time data, and a lot of sterile saline is used as various medications.

Last Friday, rather than work the floor in my clinical rotation, I volunteered to be a nurse during medical student simulations. These students just entered their 4th year of med school and were beginning their month of ER rotations. The role of the nursing student was to act as the nurse for the simulation: assess, advocate for the patient, collaborate with the physicians, and administer medications while the doctors continued to formulate a care plan. We were not being graded or evaluated, the med students were.

It. Was. Awesome!

My fellow nurses and I got one other benefit over the doctors: we were able to go through the simulations twice. Group 1 rotated from 8-10 and Group 2 rotated 10-12. The first simulation was a practice for all of us – what was I to ask the doctor? The patient? Focus on in regards to care? What information did I need to assist the doctors and the patient? Because of the nature of simulations and how much students should not know before participation, I will refrain from specifics of the scenarios. All three were common emergencies, and one involved pediatrics. I was thankful for two semesters of Med-Surg, so I was way more comfortable with these scenarios than I would have been in January.

I felt as though I hit a stride as a nurse that second time around – the other nurse and I knew the outcomes and what to watch for while the med students were new to the situation. Also, the group the second time around had a GREAT sense of humor. I was asking for more clarity in orders: how much oxygen do you want? What drug and what dosage? Is that an order or an idea? Do you really want to give that heparin sub-Q when the patient already has IV access? By the way, your patient has below 85% Oxygen saturation for the last minute.

At the end of the day, one area stood out: patient advocacy. During one simulation, the benefits of morphine were being debated. Yes, the patient could have been given it, but it doesn’t improve mortality. Thus to a doctor’s mind, there was not convincing enough evidence to warrant a morphine administration. With Group 1, I didn’t push back on the students to order a pain killer. With the second group, I questioned.

“He’s in a lot of pain. Could we give him something for that?”

“Nah. Morphine doesn’t help long term.”

“What about Fentanyl or something else.”

(Voice from speaker) “The simulation is over.”

In post-conference, we talked about the simulation, when drugs were given, and the plan of care. We were about ready to leave when I stated my point. “Just one thing from the nurses. When it came to whether or not to give morphine, I know it does not solve the root cause of this patient’s problem, but to that patient, his pain is why he’s here. Giving half to 1 mil of morphine will ease anxiety, knock the pain down, and to that patient, you are doing something. As nurses, we’re trained to assess and we’ll hear a lot about a patient’s pain. Again, it’s not solving the root issue, but you are doing something. And that will get you far with them.”

My point was not ignored. Instead, the medical school instructor VALIDATED my point.

“That is a good point. As medical students, you need to know that by the time the nurse has time to call you to change or up the pain meds, she’s heard about it at least 12 times.”

I could have kissed that man.

Bullied: Part 1

Do you remember the first time you saw yourself in the mirror and finally had a shred of hope that you just might be physically attractive and desirable? That you were not the despicable and horrible human that others kept saying you were for so long?

It was the summer I turned 15; my family had moved back to Kansas the previous year after 6 ½ in South Dakota. While I had a minor disappointment with a boy the past year, I had been getting some attention from others and had successes in extra-curricular activities about my confidence. I was uncertain on what to do with compliments. If I said “Thank you,” I feared I would look like a snob, but if I ignored them, it would be rude. I think I usually stammered or tried to shrug things off.

It was a day I had very little planned. I was still in my PJs at the breakfast table when my brother came from the basement. He thought I was wearing a casual sundress for the day and is a pretty cool guy when it comes to his sisters. He asked, “Where did you get that dress?” in the way that men from my family say with uncertainty on how to word a compliment, yet in a way that the women know the men noticed.

“Um, Jeff, these are my PJs.”

Him: “Oh.”

After that comment and finishing breakfast, I walked back to my room to change into my real clothes for the day. At the end of the short, narrow hallway was an oval mirror. I caught a glimpse I had never considered before. It wasn’t an imaginary catwalk to my room, or a trial run of how I would saunter through The Mall. Just enough of a second glance to where I could say, “Maybe I’m not fat and ugly.” My self-esteem and self-perception were still hovering above empty, but there was something about those 10 feet down the hall that gave me hope. Not everyone was out to be better than me. My obvious features of height and hips were not necessarily a negative. And maybe my acne-prone face and shoulders weren’t as horrible as others made it seem.

I still had plenty of emotional breakdowns between that moment and now. I still considered shopping a war and personal assault. The number on the size was all-important as to how I felt about myself for the next month or so.  Some hurts have scabbed over, yet I’m reminded of their scars at the most random times. Just when I think that I’ve answered all the questions and satiated the emotional holes left from my middle school years, the emptiness slinks in the cracks on bad days.

The mid-90s seemed more concerned with sexual harassment and whether or not kids knew about HIV transmission. The line between “kids being kids” and bullying had not gotten the attention of the past 10 years. Sometimes I wonder how I would feel if I could have stood up for myself in the schoolyard. What if one day I would have just punched someone in the face? What if I could sue for the therapy bills not covered by insurance? What if I had taken a few more sick days or convinced my parents to get me out of that school?

What happened cannot be changed. But I have hope. Not because I saw myself as pretty one summer day, half my life ago.

Because I’m learning to forgive people that I will never see again and who will never know how deeply their words cut to my heart. Because I can look at the world around and know that God created things that are good. Because I am to look and myself and say that I am the chief of sinners and forgive others’ trespasses, debts, and sins.

It is not easy, nor should anyone be demanded to produce these results overnight. Be filled with Truth to combat the lies. That is the first step. The other steps will follow, but always seek Truth.

Hospice Nursing

We knew the discussion was coming based on our pre-class preparation videos.

My group was having a discussion on end-of-life care and how hospice nursing is different than other kinds of nursing. We delved into the ethics of giving morphine or other comfort measures that may or may not drop our patient’s O2 saturation lower. I was of the few students who had experience with hospice care and nursing. Caring for The Brain had been most of my formative hospice experience, however, I have had other family members in hospice care and a good friend described her experience with hospice in relation to her mother’s illness.

Hospice nursing is different.

Your patient will not get better. He/She will not walk out of the facility or their home cured and on the path to wellness. “Wellness”, for a hospice patient, is more based on their comfort and whether or not there is peace at the end of life. You meet amazing people with interesting lives, yet you are usually meeting them at the end of their life’s journey.

In describing the above, and using almost the exact words, I teared and choked up in front of my colleagues. I thought of The Brain and my aunt and my grandma.

It’s easy to feel defeated on the floors as a nurse – I didn’t get patient medications on time, I failed to call the nurse or someone about the patient, the patient did not get to walk exactly when s/he called for me, the patient bathed 2 hours after s/he asked for a set up because I was held up in other patient rooms or needing to get vital signs on everyone before the next rounds.

But how does a hospice nurse not feel defeated? Every patient is choosing to stop life-prolonging measures and has, to some degree, accepted death as the resolution to their disease. It is a different form of nursing to know that you have helped your patient live well and provided them with comfort and anxiety relief. You have given the patient utmost consideration, care, dignity and security. You assure them that their body will be treated respectfully when they pass away.

And until those final moments, you share memories. You swap recipes for favorite meals. You hear about the patient’s life, passion, and wishes for care. You look at their choice for a casket or urn. You ask what they need and what the family and caregivers need. You are a nurse that stares death in the face and tells it that just because it is lingering does not mean there is fear.