For the love of nurses

nurses-uniformI passed the boards, in case you were wondering.  It’s a relief.  I don’t have to think about that again for 10 years.  Who knows, by then I may be retired.  Or a famous writer.  Or still doing the same thing I’m doing now, the job I love.  I have found a new delightful rhythm in my work.  It feels refreshing instead of draining.  I am on the other side of something sinister.  My steps feel lighter, my laugh less restrained, my love for this work blossoming.  I have my favorite nurse back in a new place and it makes all the difference.

My husband recently said something genius, “you are only as good as your worst nurse,” and he’s so right.  Physicians often feel very alone and isolated, our life and death decisions are made in our own heads, the consequences resting on our shoulders, the burdens felt in our hearts, any bad outcomes solely for our conscience, but I’m never truly alone in my work.  There are so many people that I depend on and need to help me do the best job possible for the patient.  I can’t do it alone.  Being alone is exhausting.  When the people that I need to help me do my job instead work against me, it’s a perfect storm for burnout.

A lot of the time, I get all the credit.  The relationship is built predominately between me and the patient, I am the one they want to talk to on the phone, the one that gets all the accolades when things go right, the one that gets the baked cakes and Christmas cards.  Like my husband said, I’m only as good as my worst nurse, and I have the best nurse, she makes me look good.  She makes me a better doctor.

There have been times that I haven’t given nurses enough credit.  Sure, sometimes they can be annoying, offering their own advise to patients that may not be exactly what I’d say, taking it upon themselves to diagnose an illness (thus taking away my thunder), forming their own special relationships with the patients, offering advise on tests to order, pointing out medication errors, and just plain doing a good job for the patient.  For a doctor, trying to navigate a strange field where our degrees and our licenses allot us great responsibility and great rewards, but come with great sacrifices and great burdens, sometimes it is difficult to allow a nurse to have his/her say.  It is hard to give them the credit that they deserve, to admit how much we need them, or to recognize the depth of knowledge, wisdom, and experience that they possess.

I have the best nurse.  I know this for so many reasons, but recently it was because she showed me she cares for these patients as much as I do.  When one of our patients recently passed away, we both got tears in our eyes and reminisced about him.  He was just as much her patient as mine.  He touched her heart and I discovered that I’m not the only one who carries the burdens of this job.

I trust her implicitly.  She has the best interests of the patient at heart and therefore, my best interests.  She’s my right hand.  Nurses are life saving, not only for the patients, but for the doctors too.  My nurse is the best.  I am so grateful to work with her.

 

 

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Be Kind, Unwind

Unknown-1The unwind.  That’s where I find myself right now.  It’s this strange process, like a colon cleanse or some such shit, whereby I untangle myself from the trappings of my job, just briefly, while on vacation.  This unwind doesn’t last. It really never processes to completion, anyway.  In fact, it’s kind of a tease.  I can never truly unwind myself from this work.

On the agenda today, the one and only house cat museum in America and the train wreckage from the movie, The Fugitive.  Both happen to be located in Sylva, NC, about a 2 hour drive from our home.  I’ll drive, the kids will be in the back of the minivan, arguing about movie choices and snacking, contributing to the layers of crumbs that have accumulated on the floorboards.  Which reminds me, I need to find time to vacuum the minivan before I go back to work next week.

Tomorrow, a cat cafe in Charlotte and a train museum in South Carolina.  Do you sense a trend, yet?  Cats and Trains.  This is how I will unwind.  Not because these are my choices, but my kids’.  The youngest likes cats, the oldest likes trains, so I oblige.  They are off for Spring Break and I took the same week off from work so that we could go on adventures together.  If it were up to me, we’d be in Bath, Beaufort, and Ocracoke following the path of the pirate, Blackbeard, as he traipsed through NC, but my kids nixed that idea.  They said it was too scary, so we stayed home taking day trips about cats and trains.  I accidentally mentioned a ghost tour in Beaufort and that was it for them.  Nope.  Don’t want to go.  I wouldn’t have made them do the ghost tour, anyway.  Little turds.

I have already been in my work computer this morning to make sure there weren’t any pressing messages.  So much for the unwind.  12 messages, 15 med refills, 10 lab results, 1 patient email.  Don’t they know I’m on vacation?  It really never ends.  Maybe that will be the worst of it.  Mondays are usually insane, it can only get better from here.

I plan to check my computer every other day, but this part of me, the part wound the tightest can’t rest until I know there is nothing “bad” waiting for me.  I just need to know. I just need to fix it before someone gets hurt.

I know I’m being a bit over dramatic. It’s part of the unwind.  It resists.

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Wrinkles of Time

51NL8VCyZqL._AC_UL320_SR210,320_My favorite childhood book was A Wrinkle in Time.  I don’t think it was because the story was anything special, but because my favorite person in the world told me it was her favorite story.  She lowered herself to my level, looked me directly in the eyes, the eyes of a 10 year old who didn’t know anyone really even saw her and said, this is my favorite story ever, and I want you to read it.  

She handed me the book, her copy, worn and tattered, dog-eared with the binding bearing the grooved lines of having been open and shut numerous times, lying face down on a night stand awaiting the reader to return at daybreak.

I read the book, the first book I had read all by myself.  I read it in secret, not because my parents wouldn’t approve, but because they really weren’t paying much attention to me anyway.

I loved the story because I loved my teacher who lent me her own personal copy.  She was so integral in my life at that time.  My home life was not particularly calm.  In fact, most of my memories of my home life back then were my mother anxiously anticipating my father’s level of drunkenness and therefore deciding whether we needed to stay at a hotel or if it was safe to sleep in our own beds that night.  I kept a duffel bag with pajamas and school clothes next to my bed just in case.

There is very little about the original story that I remember as an adult, but it still remains my go-to “favorite” book.  I just remember a missing father and time travel.  A missing father seemed less of a nightmare to me at that time, maybe because I welcomed the idea.

When I heard that a movie was being released, I jumped at the chance to revisit the story, but this time with my own children, ages 7 and 9.  We have been reading it nightly for the past month or so.  I’m not sure if this was a mistake on my part, as I haven’t enjoyed it as much as I thought I would.  I really can’t put it to words, but now I am reading it with an adult mind, one that has escaped such a childhood, one that has made amends and even friends with a father that once tormented me.

I am reading it with a mind that remembers my favorite teacher getting a divorce, changing her last name, and dying from breast cancer.  The weirdest thing I can say is that I still remember how she smelled when she would bend down to my level, look me in the eyes, and tell me how proud she was of me.  She smelled like gardenias.  She was my favorite person.  After she died, they named a road after her.  A road that ran passed the middle school where she taught in her final days.  She must have been other students favorite person, too, to have a road named after her.  I wonder how many of them were lucky enough to read her copy of A Wrinkle in Time.

Secretly, I hope none of them had the luxury, I hope that I was the only one.

 

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Board to Death

UnknownEvery 7 or 10 years, I have to retake my medical boards.  I am currently board certified, but have to prove it over and over again throughout my career.  If I jump through a bunch of hoops, like taking certain designated classes, performing modest in-office studies, and accruing a certain amount of CME between board tests, then I get to retake the boards every 10 years.  If I fail to jump through these hoops, then it’s every 7 years.

If I don’t take them at all, I can still practice, but I lose my board certification, and likely if employed (which I am), I could lose my job.

Sounds so boring, right?  Let me tell you, it is.  Studying for the boards is awful.  The last time I took them I was newly married with a bun in the oven and just starting my career.  I had time.  I had energy.  Now I’ve got 2 rowdy kids, with lots of nighttime activities, and a busy practice.  It’s harder to study now.  I’ve gotten old.

You’d thing just being in practice for the past 10+ years means studying is not necessary.  Isn’t every day just a series of pop quizzes for the boards?  Sort of.  Except answers to questions on the boards don’t always translate to how one practices in the real world.  For instance, an MRI might be the right test to order to diagnose a particular illness on the boards, but in real life, the insurance company won’t pay for it, so one orders the ultrasound instead.  So I have to study for the test so to speak.  What would the right answer be for the boards, not for real life.

The worst part would be to fail.  It could happen, you know.  I could get cocky.  I could be lazy.  I could blame my failure on the stressors surrounding this time, like the recent move from a practice that I was in for almost 11 years to another one closer to home, not necessarily because it was closer to home, but because the alternative was intolerable.

Staying was worse than leaving.  Leaving was intensely emotional and stressful, not only for me, but for my patients, for some of my previous staff, for the new office, their staff, their providers, and all the administrators that facilitated the move, but it was preferable to the stressors of staying.  It was hard, but it was worth it.  The move happened right smack dab in the middle of studying for the boards.  It happened without much of a plan and it happened quick.

There will be another move at some point.  I keep saying a year, but who knows.  I have been working with my employers for a while, expressing my desire to move my practice closer to home, sending them pictures in emails of offices for sale or rent in my town, meeting with them over meals, discussing the benefits to the corporation of having a practice closer to them, too.  Finally, they emailed me back.  None of the locations I had sent them all summer long were appropriate.

Instead, they were going to build a practice.  They sent me the plans.  We met and brainstormed ideas on how to best use the space.  I asked for a “multi-purpose” room for lectures and meetings, but mostly for group yoga.

But it would take time.

In the meantime, I have my boards.  I need to pass my boards.

 

 

 

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Shamrock Shootout

images-1My daughter is 7.  She is in the first grade.  It’s a sweet time of life because she still likes me and she still wants to be seen with me.  In fact, she requests my presence the mornings that I drop her off at school.  She wants me to walk her to her class instead of dropping her off in the car line.  I walk her to class and she always gives me an awkward side hug before she goes inside.  It’s hip to hip with an arm barely slung over the back.  It’s kind of pitiful as hugs go, but I don’t push it.  I want to embrace her, even give her a kiss on the cheek, profess my undying maternal love for her, but I resist.  I relent.  She’s building street cred and I don’t want to get in the way of such important work.

I’m not entirely sure how the awkward side hug came about because we are full frontal huggers in this family.  We hug for too long, no one giving up their end of the hug before the other.  I guess that’s another version of an awkward hug.  We are the kind of huggers that hold tightly, loosening the embrace to sense the integrity of the hug from the other person, but not fully letting go.  If their hug remains steadfast, well by golly, we re-squeeze.  This could go on for a while.  Too long, if you ask me.  I often push away first.  You are suffocating me!!  I think my husband started this, because he hugs forever.  It’s totally awkward.  And it drives me crazy.  I think he finds humor in the squirming that the hugger (him) causes the huggee (me).

I walk with her to class and she typically hangs up her jacket, her back pack, and her lunch box.  She pulls out her notebook, water bottle, snack, and balances them in one arm while giving me the awkward side hug with the other.  Then she bounces into class without a backward glance or goodbye.  It’s the same thing every time.

The kindergarteners are in the room right next door.  I often watch them come and go, their mommies and daddies shuffling them to class, their teacher greeting them only the way a kindergarten teacher can, dressed in full holiday attire -right now it’s all green for St Patrick’s Day, with leprechaun-inspired headband (imagine rainbow with a pot of gold on top of her head held steadfast and immobile), a glittery shamrock t-shirt, and green leggings.

While I waited for my daughter to unpack her things, the kindergarteners appeared to be all in a tizzy.  Something had happened in the night!  All of their chairs were stacked on top of their desks!  How did this happen, they asked?  The Kindergarten teacher, dressed for the occasion, told them about the Leprechaun that must have wreaked havoc in their classroom in the middle of the night.  She explained that they were going to devise a trap to catch him, but he was smart and quick, a mischievous sort, harmless, but prone to causing trouble.  They buzzed with excitement, each of them shouting out ideas simultaneously for the trap that they would build to catch him.

Each day, another incident would befall the Kindergarteners.  One day the chairs were lined up in the hallway, another they were piled haphazardly where they hung their backpacks.  They just could not seem to catch that leprechaun!

In the midst of the leprechaun’s antics, it occurred to me that some people have proposed that teachers be trained to carry and then potentially use a gun to protect their students while in school.  Teachers like this kindergarten teacher with her green leggings and silly hair accessories, with her overly bubbly and energetic personality, with her whimsy.  Could I imagine this woman concealing a weapon on her person?  She’s the kind of teacher where the kids leap into her arms and give her great big hugs.  How would a weapon in a holster affect that kind of relationship?  Would hugs be off limits?

I tried to imagine her with her green glittery shamrock t-shirt, grabbing her gun in both hands, aiming at another human being and pulling the trigger.  Can the same person that dreams up leprechauns to inspire the imaginations of her 5 year old students be willing or able to shoot a gun while her frightened wards huddled in the corner?  Even if she could, would her pistol, likely held in trembling hands, fire a bullet that would hit it’s intended victim?  What if a child were killed instead?  What if the perpetrator had a more powerful weapon, she would be outgunned, out-trained, and all that cost, all that fear, all those awkward and avoided hugs would be for nothing.

Kindergarten teachers should be kindergarten teachers, not trained marksmen, killers, judges, and executioners.

My daughter was ready to go into her first grade classroom.  She went to give me that awkward side hug again, but this time I stopped her.  No, I want a real hug.  She gave me that side-eye of hers that albeit cute now will probably become rage-inducing when she is a teenager.  She sighed, put her notebook, drink, and snack on the ground and allowed me to give her a proper hug and she gave one right back.  Then she picked up her things and bounced into class without turning around or looking back.

 

 

 

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Take Me to Church

abandoned-church-milfordLet me tell you why church is hard.

Trying to convince me that the Bible isn’t science but it is absolute truth about the beginning of time.  Using examples like giraffes and language to explain divine design.  Making fun of a scientist that said language probably just started with one lone genius who then taught the rest of us words.  A man in the back of the room yelling out, “no that couldn’t be true, a man would never do that, it must have been a woman.”

The whole group groaning.  The women rolling their eyes.  Leaving there feeling that my words are too much.  Not enough.  Just shut the fuck up.  You and me both.

Denying the oven that our world is becoming because God promised no more floods.  But floods still happen.  Yes, but it won’t wipe out the entire human race, just a few people along a river, here and there.  The icebergs are melting the oceans are rising, but it won’t be a flood.  It will be fire.  And only God can do that, we have no way to influence this.  Man made global warming is a hoax.  Only God can do that.

God made man and then He made woman.  But what about mitochondria?  Well, what the hell is that?  Only the main reason we exist.  Some weird glitch in evolution where a bacteria hitched a ride in our cells and powered the whole shebang.  Mitochondria can only be passed from mother to child.  All the mitochondria in all the world came from our mothers.  The poor sperm have no equivalent.  Women do rule the world.  The world just forgot to tell us.  And who’d want to rule this shithole, anyway?

But I believe in God.  I believe in something outside of myself.  I also know that science has not disproven God, but the church is trying to disprove science.  I proclaim we will never know all the answers.  We even ingested the fruit and still to no avail.  We will never know all the secrets, but I still yearn to find out.  I still want to try to unlock the secrets.  I still want to grow closer to God.  I want to learn the mechanisms of the design by the great designer.  Denying science is a denial of God, for we face the explanation of the design and say, no that’s not right.  God wouldn’t do it that way.  He would just say “poof” and that would be it.  No change, no evolving, no becoming.  Even in my own lifetime, I am changing, adapting, becoming.  Following a path that He has imagined to lead to His greatest good.  Church is hard because if they knew I felt this way, they would turn their backs on me and walk away.

 

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After The Ending

_DSC0210My husband and I sat across from each other in Chick Fil A.  Not the most clever of places for us to have a date night, but it was last minute, it was raining outside, and we desperately needed to go to the grocery store, which just happened to be across the street, before we picked up the kids.  My dad agreed to watch the kids so that we could spend a few hours together, uninterrupted, to try to process the goings on of the past week.

“Aren’t you glad that life changing events don’t happen every day?” I asked, “it’s exhausting.”

He agreed.  After much discussion, we sat in silence. I was nursing a milkshake, my drug of choice, while he ate a chicken wrap.  He leaned in and talked in a whisper. He told me that the people to my left were the parents of the medic who pronounced my mom deceased on our living room floor over a year ago.  Enough time has gone by since my mom’s passing that such alarming coincidences didn’t cause me to erupt into uncontrollable sobs.  I’m not sure if I ever really erupted into uncontrollable sobs, at least not in public, and certainly not while the sun was shining.   Those moments happened at 3 am when I couldn’t sleep, or when I awoke from a dream where I casually run into her at out favorite junk store, Goodwill, as if she were just out for the day and hadn’t ceased to exist entirely, where she tells me, amongst the forgotten and discarded housewares, that everything is going to be all right.

I briefly imagined myself going up to these strangers in Chick Fil A and introducing myself, but what would I say exactly?  Your daughter and I tag teamed CPR on my dying mother. Your daughter was there on the worst night of my life.  A total stranger, whom I could not even pick out of a lineup, except my husband says you gave birth to her and raised her.  Thank you!  Nice to meet you!  Enjoy your chicken!

The moment passed.  They were leaving.

Earlier that day, my dad told me that his best car buddy was in Hospice.  He called him his best friend.  His heart was failing, he was extubated from the machines that kept his heart beating and his lungs breathing, and now the wait for the end began.  I casually joked that his irritation at my dad taking apart the rear end of his Ford Falcon probably did him in.  My dad said, “that wasn’t nice.”

“I’m sorry dad, I was just trying to make you laugh.  I was just joking.”

“I know,” my dad said, “I love you.”

“I love you, too, dad, and I am sorry.”

I ended up hurting a hurt man.  It weighed on my mind as I obnoxiously slurped the last remnants of my milkshake.  There was some magic to be found in that shake and I would be damned if I missed it by leaving any bits behind.  I would have licked the insides clean if I were alone, but I wasn’t so far gone that I lost all knowledge of common social graces.  I had had enough anyway.  Enough of this milkshake.  Enough of the drama.  Enough of the heartbreak.  Enough of the double standards.  I had reached the end of the line, it was time for an extubation of sorts from a machine that didn’t sustain me, but drained me.

For the first time in longer than I care to admit, sitting with my husband in Chick Fil A, with a belly full of milkshake, rehashing this crazier than usual week, holding the pain that my father felt for his dying friend, the pain that I felt for not fully grieving my own mother, I actually felt relief.  I actually felt peace.  I was standing in the space between endings and beginnings, desperation and resolution, fear and tranquility.  Birth and death, then death and birth and I was actually good.  Really, really good.

 

 

 

 

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