Mandatory End-of-Year Reflection, 2021

And somehow the world has continued to turn.  Even at the moments when it felt like everything had stopped or maybe should have stopped, when we were too heavy to carry any further.  Time still pressed forward.  Tomorrow came.  Maybe it looked a hair different than expected, but tomorrow still came.  

There are a lot of things to be thankful for; there are a lot of things to mourn; and both exist in the same space.  There are parts of the world that are somehow exactly the same and other parts that more resemble a dystopian hellscape.  

We watched people selfishly refuse to get vaccinated, denying their responsibility in a society while trying to retain all the benefits of it.  Again, what someone does in the privacy of their own home or what decisions they make that only affects themselves does not bother me; not stopping at red lights, jumping the counter to make your own coffee at Starbucks, and refusing to get vaccinated, I have a lot to say about that because of how it ripples out to others.  As such, COVID has continued to evolve and evolve again in that space created for it by those people who repeat the eugenics argument that we should simply let it "run its course," and accept that it is okay to sacrifice people for their expected comfort (because no eugenicist, low-key or otherwise, thinks that they are going to be the one expunged).  Smallpox ravaged the world for literal millennia; COVID could well be on course to do the same, if we continue to let it.  And there are days now as a nurse where I have to wipe the ass of someone that denies the effects of COVID as they are currently suffering from it, demanding that we subscribe to some ridiculous internet hearsay as their preferred treatment (we won't), making me wonder yet again why they came to the hospital in the first place if they are decrying the correct treatment as poison.  We watched people storm the capital, with the bodies that encouraged them still yet to be held accountable.  Certain states have decided that women should have less bodily autonomy than what we would grant to someone that is dead.  

Consequently, the survival voices in my head say that I am not safe.  I don't think they're wrong.  And that means I take continual steps to protect myself and my household.  Unvaccinated persons are not welcome in our home, for starters.  I will continue to wear a mask.  I have stopped accepting handshakes as another small but important change.  I try to avoid spaces where there are certainly too many bodies or not enough "space."  If the collection has dubious vaccination status, I likely won't go at all, unless I know they are tested with some regularity.  I cannot afford emotionally to accidently carry anything to the people I am caring for at the hospital nor can I risk my own health, because I don't tend to get sick small-ly--when I break, I break thoroughly.  

Yes, we are all tired of the pandemic, but that doesn't mean we have the luxury of ignoring it.  It is a lot like having a chronic illness that way:  we can acknowledge that we are exhausted in more ways than we knew were possible in the same breath that we know that does not make it magically go away out of sheer force of will.  The way out is through, not forcing the old normal anyway.  Again, just like with a chronic illness, there are changes that have to happen to properly accommodate the best kind of life possible.  That can (and should) involve a grieving process, but the adaptation stage is required to live one's best forward.  Grieve the community that we miss while finding safe ways to connect anyway; grieve for the events we missed out on while looking forward to being able to do them safely in the future, because we took the right steps for longevity now, while simultaneously finding a means to meet yourself halfway.  No, it's "not the same," but the world cannot be the same again:  the world has continued to turn and it does not go backward.  

...I think I also mentioned, though, that there were things that I was grateful for.  

Andy and I will be married ten years this year, and, lordy, a great deal has changed in that time.  We are both healthier in a few ways and continuing to adapt as we need to.  We are both settled in careers now that better fit who we are as people and are both fulfilling and challenging.  

And we are thriving.  Those career changes both started this year.  I have been working for literal years toward the goal of my RN, and I still find it mind-boggling to see the fruits of my efforts.  In the same breath, I feel a bit listless, to have completed a goal that has been on the backburner if not the forefront for such a long time.  I am still trying to recalibrate my next goal more cleanly, to translate my professional goal of "Learn all the things on the floor!" into something more specific and measurable, to be able to better see my own progress.  There will always be more tips to share and gather from my peers; I will always be learning, and that excites me on many, many levels.  And at the same time, I need the measurement to help keep myself from feeling discouraged.  

Also, yes, that is a Rivian R1T in our picture up there.  Yes, it is a fully electric pick-up truck.  Yes, we love it.  Its name is "Tutti."  I know there will be days where I will eat my words here, but I am excited to be able to be the friend that has a pick-up truck when we have friends that need to borrow a pick-up truck for an afternoon.  And, yes, Andy is enjoying proselytizing for both our new truck and for Rivian in general.  To be in a place financially where it was possible to get one, that was a cool, new thing for us, particularly as I'm out of school and we're back to being DINKs again (dual income, no kids).  We get to sort out what that means for us, particularly when we get past the holidays and find what the new normal is going to be.

Truly, Andy has found a place where his passion for new technology, environmental conscientiousness, cars, and helping people all line up in one space.  It fits him.  Mike has sported a couple new tattoos this year, an act of becoming, too, where there is a certain kind of right-ness, that those images belonged there all along and have now come to fruition.  In the midst of all else going on this year, our household was about "becoming," and growing further into who we already were.  

And I think that is what I want to continue doing into the next year, embracing more of that "becoming."  There are many, many adventures planned in the upcoming years, including trying to sort out how we want to celebrate our ten-year marker.  "Becoming" is a process, and it can certainly be an uncomfortable one.  Sitting for a tattoo is a painful but varied experience, depending on the placement and design in question; learning the ropes in a company that has started delivering its first vehicles takes now small amount of flexibility; balancing the tension and urgency of the tasks that need done, the requests made in the moment, and the very real danger of certain patient situations takes every kind of mental energy there is to process and enact.  There will be stumbles--I have been reframing the small missteps in the "here's what I'm going to do better next time," while also acknowledging that it is still physically impossible for me to be all things to all people, even if it is "only" five patients.  

So I walk into the next year, optimistic, once again.  I want to continue to grow and see that in the people around me.  In the same breath, I will continue to be cautious because we have many reasons to be.  Both exist in the same space.  

Fledgling Nurse, Part 5: Not Knowing

Since NaNoWriMo has wrapped up, I've been trying to restart some books that I had been reading and a couple of series that I had been watching on Netflix and Amazon Prime.  At any given time, I tend to have somewhere between three and eight books that I will swap around between, though one will likely be my major focus at the moment.  There are a number of reasons for this, including recognizing different moods--something fluffy and comforting compared to something that is denser and requires a certain attention compared to something else that is purely for learning purposes that I'm trying to half-memorize as I go through.  I have a couple of books that I want to get through but are hard for various reasons, requiring a titration of sorts (read a small bit, recover for a week, repeat).  Specifically what comes to mind for this group is An American Sickness:  How Healthcare Became Big Business and How You Can Take it Back--it is highly informative in the same breath that it is absolutely soul-crushing and/or rage-inducing, particularly when I have been on the medication that was used as a talking point in the first chapter and experienced those points first-hand.  

Other people would probably put some of these books down.  Anything that I only read a chapter here and a chapter there, that takes months to work through, well, it probably means that I'm not necessarily enjoying it as much as I could be, that I am muscling through it.  There is no small measure of stubbornness involved.  And yet, I also just want to know how it ends.  For An American Sickness, I know it gets to a point where it will outline a solution.  I have also read books where I knew I was turned off either from how it was written or enough flaws in the structure that I was pulled out of the story...and yet, I still wanted to know the ending.  

That's happened several times over, actually, with TV series and books where I had the realization that I was not enjoying the experience necessarily but that was outweighed by my need to know how it ended.  For TV series, I have gone to Wikipedia to read episodes' synopses, to save myself literal hours of watching in order to know the ending, but usually a book I will muscle through (and then read the synopses for the rest of the books in the series if need be).  Even if I'm only mildly invested in the characters, I still want to know what happens.

...and so let's consider, then, how I might feel after spending twelve hours with a patient.  A patient I had to research regarding their past medical history, allergies, medications, and other quirks.  A patient that I have gotten to know, having specifically listened to their emotional needs in the day.  A patient that has suddenly taken a strange turn in their condition over the course of the day.  They are a person to me, AND my curiosity is piqued.  

And then I go home at the end of the day.  I may never find out what happened to them.  I could have had a patient over four different shifts that discharges or transfers on a day I'm not working and then never see them again.  It is possible to look up their chart in the computer, sure, but it is also a violation of HIPAA to do so, because I am not looking up information on them with regards to their current care.  In other words, satisfying my own personal interest is not a valid enough reason to delve into someone's private health data.  A peer might know if they went into home hospice or if they were transferred to another facility, but there's still not much of a conclusion.  Even someone that was well-ish when they discharged, I do not get to know what happens to them after the fact.  Do they keep their physical therapy appointments?  Do they have questions about their diet changes?  Are they being adequately supported by their family members for dressing changes and emotional needs?  Are they able to go back to work?  How are they considering their own mortality after this interlude?  

I have to find a way to come to terms with never knowing.  I have to let go of the patient when I clock out at the end of the day or when I transfer their care.  That not-knowing is just going to be a thing.  I do not get the satisfaction of resolution.  And I'm not specifically entitled to it, either.  It's a brief intersection of different lives and nothing more.  

There is no resolution.  There is no closure.  Some cases will bother me on that count more than others, but with all of them that is something I'm going to have to figure out how to live with and let go.

Fledgling Nurse, Part 4: Ingenuity

One of the most time-consuming parts of my day in the hospital is finding things.  I have stared at the wall of supplies in the storage room, suddenly blind to the piece I need.  I have searched all corners of the room trying to find the thermometer, and I have scoured from room to room looking for a recliner I could steal.  I have popped to another floor to borrow a bladder scanner or snag an armful of blankets when we ran out.  I have sent many, many requests to pharmacy for the one medication that is missing and wait for it to be sent up because a dosage was changed last minute or another piece had just been added.  

It takes time.  Sometimes it requires several phone calls and traipsing around the hospital to check in a couple of individual spaces.  There are occasions where it is better to beg forgiveness than ask permission...or at least sneak it back up into place before anyone seemingly notices.  There are also places where trades happen, the you can borrow X if we can borrow Y secret-handshake-swaps in the hallway (temporary exchange of bladder scanner for vein finder was one from a few weeks ago).  And if the room that you need it for is a room that requires specific PPE (personal protective equipment, such as a gown and an N95 mask as opposed to a normal procedure mask), then there is a lot of putting on and taking off and back again, and suddenly it is forty-five minutes or two hours later and you are behind on all of the morning meds.  

That, of course, is assuming that you know exactly what you're looking for.  Let's say that you are not trying to find a particular something but instead you are aiming to solve a particular problem.  Then, staring at the wall of supplies becomes a different problem.  Here's a hypothetical:  a patient cannot have a certain set of medications, they are in pain, and the best immediate solution seems to be attempting a warm compress of sorts, but the warm blankets cool off too quickly and keep sliding off in any case.  I ended up taking two ice packs, filling them with warm water, tying them together, wrapping a warm blanket around those, and then wrapping another around the body itself that held the specific limb in place.  It wasn't elegant, but it was functional while we were sorting out other details and other options.  There have been many, many times when I have walked into a room and thought "what is this hot mess?" only to untangle a pocket of genius that I could refine as the day went along.  Other times, it is just a hot mess, and we can scrap the idea to then try something else.  Techs, nurses, and other members of the team can find some glorious, creative solutions to so many interesting situations.  There are simple questions (How do I take blood pressure on someone whose arms we can't put a cuff on?  Use a leg.), there are daily questions (this man's anatomy does not work well with the external catheter--use the other kind but backwards), and there are some that will likely never happen again but still help inform how we approach adjacent questions in the future (too specific to mention here).  

This is also assuming that one has the capacity to well identify a the right problem.  It's a particular skillset to look at a situation, to take a vague discomfort and turn it into something actionable.  Turning a generic frustration into something that you can do to directly address it, that takes a certain amount of critical thinking combined with active listening--it's easy to latch on to one part of the conversation while ignoring the core.  This also takes time, to suss out a series of complaints into steps.  The real secret, though, is that the core has to be identified, even if it cannot be acted on directly.  It needs acknowledgement.  Solving a couple of the smaller pieces can help, but simply acknowledging the core tends to help much, much more.  A very common one I see in my patients is that they feel out of control in the situation.  If I interrupt the first part of the tirade where the patient complains of being cold by offering a blanket, then we might not get to the real reason of the frustration.  It's important to listen fully, and it's difficult to be patient enough to do so.  I tend to let them list out everything and then repeat back parts with "So what I'm hearing is..." to check for clarity, allow for additions, and then end the conversation by validating their feelings and repeating the list of actionable steps we have made.  As long as I can fulfill my verbal contract or keep them updated on ways it could not be, I have earned their trust.  

Now, in addition to solving an already existing problem, there is an additional skill--preempting potential or even related issues.  This is an entirely different skillset and frankly it is an artform.  It is a very helpful one to have in nursing, most certainly.  Can I deescalate a patient's feelings of lack of control by offering small choices, like whether they would like their door open or closed?  I can also call them before I go into the room to see if there is anything else I can bring with me before I go in, saving myself a trip in addition to allowing them voice into the situation.  They keep asking for water when I go in, so maybe I can bring a fresh one in with me anyway.  Again, it takes a certain kind of mental energy, intentional forethought to put myself through possible hypotheticals of what I might need and then see if they might also fit for the patient's circumstance.  I should also be considering potential issues in the room, such as whether the path to the bathroom would be clear if they had a sudden emergent need.  Is their phone charger plugged in and in reach?  

All of these facets are using different levels of critical thinking, on top of that other critical thinking that I need to do, like watching trending vital signs for new potential issues.  

So, long story short, at the end of the day, my brain hurts.

Peterson Family Update, #90283334 Mu

I don't know what happened for November.  I blinked, and then we were a week into December.  Time to deploy the bulleted list once more!

• If anyone did not see last week, I won NaNoWriMo!  This was probably a significant factor into why November flew for me, given that any free time I had was slated into that space instead.  There were some good swatches that came out and a few places where it was a performative, perfunctory mess.  There is more to add when I get to the editing process, but it is a glorious thing to have the raw material to edit.  It's nice to pause to bask in that idea as well as the accomplishment.  
• Luna does not have a perfect grasp on the schedule, which included a stretch of time where she was barking at 0230 for about a week.  There may have been some interesting outside force--a loose panel making noise from somewhere, an outside cat wandering around the area, etc.--but it was a frustrating week.  It was around daylight savings time, which also probably added to the fun.  She's mostly readjusted, in that she is adjusting to a schedule that is not consistent:  when I have a shift (which is not standard from week to week), I take her out and feed her before I leave, meaning that food happens around 0630; on other days, Andy is more likely to get her rolling closer to 0800.  She's a trooper.  And a derp factory.  
• Andy is still loving his job at Rivian and things are certain flavor of busy there with deliveries taking off.  December promises to be equally if not more busy.  We had the opportunity to go to the First Mile event, where Andy actually drove an R1T (I was in the backseat).  It was a ton of fun.

• I have been orientation now for just shy of a month.  Yes, I daresay it is finally starting to feel real, to the point where my initial discomfort in stating "I am a nurse," has officially dissipated--I'm in the club now.  I have a sense of belonging that is settling in.  I am carving a niche for myself in pieces:  one of my roles is "pharmacy," since I keep my locker stocked with tylenol, ibuprofen, and the like.  It's a small but important thing I can do to help support some of my team.  
• There are also a lot of bizarre situations that happen on a shift, including (but not limited to) the following:  patients insisting on the bullshit COVID "treatments" that they heard about online, some attempting to manipulate myself and other staff emotionally, family drama that we get pulled into, gentle (and not so gentle) reorienting of persons who are highly confused and/or forgetful, differences with opinions with the doctors, a sudden new symptom that had not been there earlier today that is simply weird, having something literally thrown at your body (which then leads to a call to security), a patient that has figured out the fall alarm is a quick way to get attention when they're feeling bored and just want to talk, and then walking into the next room like none of those pieces happened.  A lot can happen in twelve hours.  Yet, with all that, I feel that I am getting something of a footing--knowing that I can never know everything is oddly reassuring; knowing that I will also continue to ask questions and continue to learn is exciting to me.  I am in a good place.  It is exhausting, certainly, but I am being challenged in ways that I find fulfilling.  That doesn't mean there are moments I want to Rage!Quit (╯°□°)╯︵ ┻━┻ and vent, but I accept this as an aspect of the day, finding those spaces where it is worth fighting.  Hell, there have been a couple of places where I've stated with patients directly that "Nope, I'm setting a boundary here," and explain what it not okay.  As a rule, I try to give grace to persons that cross a boundary that they did not know was there, but I will absolutely not tolerate someone that continues to cross a boundary that has been clarified.  I am trying to learn where I need to set these sooner, before they reach critical mass.
• I have seen a few of my peers walking around in their blue scrubs--it's edifying to see us there together.  I also enjoy collecting the names of the food staff, the housekeeping staff, restocking, and all else that help keep the hospital functioning.  Though, I think I have definitely worried a few of them when I abruptly come in with "Hey, what's your name?" and my explanation of "I'm collecting names as I go," probably has not reassured many people, now that I think on it.  Ah, well, at least they know I'm a certain flavor of strange--mostly harmless, but strange.  
• I think it is fair to say that Mike is keenly remembering holiday seasons of Starbucks' past, and finding his own spaces to recuperate where need be.
• I did a bit of house decorating for the holidays, though I haven't broken out much for interior pieces yet.  Mostly I'm proud of this idea, having taken down the messy nest of dead morning glory vines to change up this space with something simple but festive.  

• Otherwise, a significant portion of my updates seem to hover over work at the moment.  It is occupying much of my conscious thought, and, yes, I do hear IV and bed alarms when I try to go to sleep sometimes.  I've been trying to reach out in spurts to people again, too, grabbing a meal here or a catch-up call there in a few places, and hoping someone else can take the initiative in others for a while.  

December promises to be an interesting end to the year, one way or the other.  There are more blogs to write and more adventures to document.  

I Did the Thing

I won NaNoWriMo again this year.  :D  My brain hurts, but there is definitely more to add to this project before it feels "done."  Still, it's time for a well-deserved rest and back to our regularly scheduled blogs starting next week.  

Much love, all.

Another Excerpt

Yeah, most of my writing energy is still going to NaNoWriMo right now.  Just crossed the 25K threshold this week.  Here's another Ordinary Thing:

"Liminal Space

There are weird intersections in the world where time does not feel like it moves correctly.  Spaces that feel like an odd intersection of time.  A hospital hallway at night, for example, feels outside of time, that people and time both pass in the hallway but somehow without actually touching one another, walking alongside each other but not affecting the other.  Alone in the early hours of the morning, before the sun is up, I have my own space in the kitchen.  No other sounds except for my dog adjusting herself, the hum of the refrigerator and whatever I might put directly in my ears.  This morning, the sound of my keyboard is also present, gently but steadily clacking away in bursts at a time.  My dog has found her favorite spot on the couch as we adjust to the waking day together.  She will adjust by going back to sleep; I will take the same kind of peace for a moment or two longer, finding that pausing to acknowledge and dwell in the in between spaces is a good moment to run a self systems check, notice the taste of my coffee, and otherwise allow my mind to wander a bit further before jumping into the full weight of the day.  

A few words written before the day even really starts, dressed and prepared for more active spaces but waiting in a relaxation state if only for a moment.  The day promises to be a full one, but this moment is mine at least, a moment that is outside of time and space.  I feel vast and thin, stretching my mind out without trying to force it in one particular direction, allowing it to move to the crevices I had been avoiding or to find a new outcropping that I had not noticed fully before.  It’s a safe space to wander if only for a moment, where I can control the input without outside demands.  I notice my shoulders hunched forward and ask them gently to release.  I notice the tension in my temples and ask those muscles to calm as well.  One more deep breath to release the stiffness in my thoracic cavity.  And another deep breath just because it feels good, noticing how the breath feels in my body, moving through each space with awareness and curiosity. 

For just a moment.  For just this space.  Luna will need to be fed before I leave for work, and my lunch will need to be packed and readied, but at least I have a moment here, an infinite and temporary moment that is mine and only mine."

It's NaNoWriMo Again!

 Hello, all!  

So, I blinked and October was gone.  It's November.  Somewhere before that happened, I had been considering participating in NaNoWriMo again.  NaNoWriMo stands for National Novel Writer's Month, and it presents the goal of writing 50,000 words in the month of November.  The idea is to get into a habit of writing, stressing quantity over quality for a period of time.  

It's paralyzing, sometimes, to stare at an empty page.  And it's hard when the vision in your head isn't what comes out.  There is a pattern of overanalyzing and simultaneous editing while creating that ultimately slows the whole creative process.  But to put that aside for a time, to create freely and see what happens, even having a side rant on how this particular section didn't actually work today, well, that still adds to the word count.  We can grow a habit, carving a path to make it easier for the words to flow.  At the end, now there's a pile of raw material to refine and edit.  It's a journey and is gloriously freeing.  

It's also a bit exhausting, trying to fit in a few hundred words here and there.  My current count is 15,011.

I've been working on two projects simultaneously, which allows me to move to the other when I get stuck on one.  One of them I'm calling "Ordinary Things" where I pick a random thing and describe it, the feelings around it.  The following is an excerpt from that.

Wish me luck!

"Radio

Driving around town this morning and utterly annoyed at other cars being on the road—because how dare they have the audacity to exist and want to get places, too—there was a point today when a song came on that I had not heard in a long time.  I was back in high school when it was popular.  I remember playing the radio in the shower and hearing it come on in that space in particular, feeling the humidity and warm of that space as I tried to learn the words to the verses this time, hearing it come on once again. 

I felt a small smile.  It had been overplayed to the point I stopped liking it, but now in this moment, it was an old friend whose appearance had been sweetened by a long absence.  I never did learn all of the words, but I do remember trying to sing along with it in the company of friends long gone, persons that were important at that point of my life that will always hold that importance of that particular moment in time and all the warmth that implies, but they don’t have to be a part of my current life to be a part of that snapshot in time.  I appreciate them with distance, grateful for the time we had together and recognizing the places we’ve since drifted apart into different people with a bittersweetness.  It’s okay to let go of those spaces.  It’s okay to let them stay in those places, and be grateful for that time we had without demanding the recreation of the same relationship with my current self.  We’re all different people now, but the song is exactly the same.  Refreshed by time, nostalgic by time, and an old memory of places past.  There has not been enough time to erase any cringeworthy moments of growing up, but there is a prevailing fondness.  And there is genuine joy in hearing the song, before it is time to let it pass from my mind into the next and the mental list of tasks for the morning ahead."

Fledgling Nurse, Part 3: Language

There is a different way of talking out on the floor.  Yes, there is a fair bit of jargon floating around, but that doesn't encapsulate the full flavor--no one I speak with on the floor sounds like a textbook to my ears, at least.  

My coworkers are also starting to realize that I 
come with catchphrases...

Brevity is not my strong point.  You may have noticed.  My brother told me once that I speak in essays, and I think about it from time to time, even in how I draft things I want to say and write.  It's not impossible for me to tap into brevity, but it does take a level of intentionality--the ideas tend to wind to a point at the end, coming together through various explorations of thought and verbiage.  This is more for deeper discussions and playing with hypotheticals, but there are still places that it crops up in "normal" conversation.  So I have my voice, which goes through various filters depending on the needs of the moment.  There is a dominant influence from my English major brain paired with a few successful NaNoWriMos.  In fact, the first scientific paper that I wrote and turned in for research--a completely different kind of writing--was veritably covered in red ink, slashing out my descriptive phrase, adverbial clauses, and all other facets designed to add flow.  The work was stripped to choppy sentences of only the essentials.  It was a jarring but important lesson:  the creativity came not in the wording but instead in the ideas behind the research.  I needed to consider words differently, and I'm finding that I might need to again.

As such, I have been paying attention to how people speak on the floor and I have identified three facets of communication between nurses, in no particular order:

1. Brief:  When giving report, my impulse is to frame it like a narrative, to describe the story.  Odds are the nurse receiving report would be very grateful if I spit out the specifics without the color commentary.  After all, they have four other nurses that they have to tackle to get report on four other people before than can get going on their day.  Their phone is also already going off because one of them needs to go the bathroom and the tech is helping another patient with the same already.  There are always additional irons in the fire, whether they're immediately visible or not.  We're even taught in nursing school to start with the point and then fill in the background, the whole design of the SBAR format in making a question.  When communicating with doctors, I try to tell myself that it needs to fit in an original tweet length.  Keep it simple.  Be direct.  Spit it out.  Add additional information when asked.  
2. Morbid:  Those in fields close to death tend to develop (or already have) an altered sense of humor.  It's a defense mechanism, to help release some of the pressure and otherwise to protect oneself.  We were having a conversation at the front desk one day about what happened to larger persons when they die, specifically how could someone be cremated if they didn't fit into the machine.  It was a bit uncouth from the outside, but it was fueled by genuine curiosity and something that needed levity in the midst of the stresses of the day.  As with many things, stories traded around are hilarious in retrospect but terrible in the moment, adding evidence to the axiom that tragedy + time = comedy.  As a hypothetical, discussing how a confused patient ripped out their IV or central line, in the moment there might be a chorus of "ohshitohshitohshit" and a few other choice words going through my head while deciding what to do next, but that certainly wouldn't be how I tell the story later in the day--it would become more of an epic on how my patient looked like an extra from a Halloween slasher movie.  The emotionally difficult pieces can't all be processed immediately--there are other patients that also need care that day--but there are tiny outlets to take a breath of air before diving in again.  That small gasp of air is the brightest moment in a bleak storm of terrible things.  So, no, it's not a joke for polite company to talk about blood or vomit or death or dismemberment, but the laughter is needed.  And one finds it where they have to.  
3. Constantly interrupted:  Maybe the group is talking about what happened over their vacation, but then an alarm goes off.  Or someone might be venting about something when the tech walks up with some important patient information.  Or maybe one nurse is seeking advice from another and both of their phones go off at the same time, they resume conversation and another phone goes off again.  The point is there are many conversations that start but the majority are interrupted and never resumed.  Some days, your phone truly does not stop ringing.  Pieces that need an answer--sounding board kinds of conversations--are easy to resume or start with a new body, yet there are many conversations where we're supporting our peers as people or talking about other life things that are important to us that never have an opportunity to continue.  In the beginning, I tried to wait for parts of the conversation to naturally ebb before interjecting important information.  However, then I found there never was a chance unless I just throw the information out there.  As a result, I've seen two major effects in how I approach staff conversations:  I feel an increased pressure to speak in conversation the less urgent it is, lest the opportunity fizzle out immediately, and I interrupt a hell of a lot more if there's any kind of actual urgency.  

So, yes, there is a veritable alphabet soup of acronyms, jargon, and all else floating around, but there's also a style.  There are moments to breathe and moments to laugh and moments to vent and moments to see your peers as people.  There are also spaces where we're just surviving at the moment, "eggshell fine," if you will.  I'm adjusting my scripts as I go, finding what pieces I'm going to keep and refine.  

Definitely going to work on the brevity thing.  Eventually.  

Seek, Rather than Avoid

In in the vein of trauma informed thinking, I was discussing with my therapist my worries about being idle.  When I have idle time, the first day is spent adjusting to it, the second day is glorious, and by the end of the third day, I'm starting to feel uncomfortable.  Being still reminds me of places in my life where I was forced to slow down, isolated in my recuperation periods.  

As such, I tend to like being busy--even as a base scaffolding of sorts--as a protective measure.  The gap at the end of nursing school, before orientation began, I wanted to try something different.  My therapist and I discussed that avoiding pain wasn't always as successful as seeking pleasure.  That is to say, trying to force the absence is hard; replacing on the other hand is often a more successful plan.  It was a new perspective on an old concern.  Hell, I hear it works for training animals--replacing a behavior rather than stopping a behavior by, say, teaching a dog to grab a pillow when someone is at the door instead of stopping barking--so why not take advantage of our own wiring?  

This means that I had to manage a couple of steps:  

• Intentionally ask myself what I was feeling in those spaces and allowing myself to feel those spaces
• Ask instead in those spaces what I was looking forward to doing, what I was grateful to have a chance to do

Instead of focusing on existential dread, of worrying about being caught in a swell of emotions, I worked on changing the direction of my thoughts.  It's certainly still a work in progress, yet I can say that there were at least a few afternoons of fun reading and time spent hanging out with Luna that had at least a few degrees less of the typical anxiety.  

"I'm looking forward to swimming a couple of miles a week again," I told myself.  "I'm looking forward to starting my new adventure as an RN," I'd follow.  "And I am allowed to rest in the meanwhile from time to time without feeling guilty," I tell myself somewhat unsuccessfully.  

There's an interesting tension that follows sometimes, in not enjoying my rest "enough" or as efficiently as I "should."  Internalized capitalism, unnecessary self-pressure, a mixture of these and other factors come together into a perfect storm of blah conditioning.  I acknowledge the feelings that are there first, whether or not I understand the root.  The idea is to create a frameshift in how I think about things that I fear.  The impulse is to protect, to guard myself; the proposed change is not to ignore that impulse but instead direct the bulk of my energy toward what I am looking to gain, how I'm looking to grow.  

...so, you know, easy work.

Fledgling Nurse, Part 2

I was asking another new grad the other day what surprised her most in the transition between nursing school and nursing practice.  For some reason, I didn't have my own answer prepared when she reversed the question to me, which means I have specifically paying attention in a few places.  As such, I have been starting to catalogue some of the observations and victories--big or small--that I have noticed along the way.  

Fashionista of the year, yo

Time to deploy the bulleted list!

• My grip strength has gotten a bit better--I can take off the cap of the end of an IV tubing with one hand sometimes, instead of reaching into my pocket to grab out my hemostat (clamp) to quickly twist it off with a tool.  
• I have finally developed the habit of putting on my goggles before going into patient rooms, hooray!  And whenever we're in public and I cross a doorframe, I immediately look for the hand sanitizer as another habit.  
• My short term memory is improving.  Really.  The kinds of pieces that I am remembering between rooms isn't perfect, but I am retaining numbers and which medications my patients are taking when I go to collect them from the right spaces and when I gave X medication to a patient last.  I might do an assessment on a patient in the morning but get pulled in so many different directions that I cannot chart it until four hours later, but I'm retaining parts better than I thought I would and learning what kind of notes I need to take otherwise or normalizing rechecking with a patient when I don't feel certain in my memory.  Yet, I've been startled by how much I do remember, partly as I now have a flow in how I like to do my assessments.  
• I'm allowed to message doctors directly with questions.  It's encouraged, even.  And, achievement unlocked, I have already pissed off a doctor by asking reasonable questions, which means oddly enough that I feel I have "arrived."  
• Sometimes the patients we have on our floor are not in their right minds or are not capable of making their own decisions, for a great number of possible reasons.  This may permanent or temporary.  Trying to explain to someone that is confused why they can't just leave or walk around unescorted does not always go smoothly.  Recently, we had one particular patient that I was wondering if I was going to get shoved or punched by standing between them and the door.  We can try to explain and redirect, but in the end we may need to call for additional hands.  I've been reflecting on a particular experience with this patient and making decisions for what boundaries I will set next time.  
• We have hospice patients on our floor.  Honestly, I've considered going into hospice nursing specifically, so I'm grateful to have some of this experience.  I'm not afraid of grief (familiar with it in my own experiences), and I can push through places where people feel awkward.  I am glad to have dedicated space to listen and simply be present with families as they work through those spaces.   So far, I have been a part of declaring two people dead.  Both of them, however, I did not have much of a chance to meet the family, meaning that I was decidedly more of an "extra" in a pivotal moment of their shared experience.  This was surreal to me in a number of ways.  I felt my role as "accessory" and supported that as well as I could by tending to the physical and encouraging them to take any time they needed to feel what they needed to feel.  It was strange to feel adjacent to death, if that makes sense.  And then I had to turn around and be cheerful in another patient's room and overly polite for the next patient's room based on previous interactions.  There was no time--just turn around and move on, think about it later, maybe.  
• There are a lot of terms that I'm accepting and speaking that I was not so fluent in a year ago.  I might through out "peds" instead of "pediatrics" or look at my notes to see that I've written "20 G R AC, NS @ 80/hr; 22 G L FA, SL" and it makes perfect sense to me.  I mentioned as part of an explanation one day that a patient has the right to leave AMA and forgot that not everyone knows what that acronym means, let alone what some of their hypothetical patient rights might be.  
• I'm starting to find rhythms, find patterns in how I work through my day and what pieces I need to do.  Every day is different, with the various needs that my group of patients that I have.  There's that balance between setting a general pattern in the day and reacting to patient needs that crop up, from trips to the bathroom to major crises.  I come in, check my assignments, start filling out some basics about those patients on paper for my own reference, get report from the night nurse to fill in a lot of important specifics, compare that against both procedures and tasks set in Epic, gather an idea of where to start, and begin on those morning meds after prioritizing accordingly.  Every morning I need to assess my patients, to form my own opinion of how they're doing and what goals we might have for this patient today.  The song is different but the genre is the same.  There are patterns and certain things that need to be done by X point or Y point in the day.  I pick my battles and am finding which ones are worth picking.  
• I am noticing my different feelings of urgency and finding my balances between what needs to be done by X time for Y reason and what is feasible to do--when I have five different people with medications due at nine, I cannot physically be in all places at once.  Inevitably, I will walk into a patient's room for a quick thing and get stuck there for an hour, either because of a series of "well, while you're here..." or needs revealing themselves (e.g. going to deliver an IV medication and finding that their IV doesn't work anymore) or whatever else.  There are guidelines and certain things that must happen at specific times, and there are many things that should happen by a certain time and are going to happen as soon as I can and there are a few things that need to be recorded by the end of the shift (e.g. any patient education components discussed today, which I tend to sprinkle in anywhere).  
• There is so much variety in the patients that we see on our floor.  On the one hand, this can be very intimidating because there isn't a certainty to land into with enough time.  On the other, there is always something new to learn, which I find thrilling.  Additionally, there is freedom in knowing that I won't be able to know everything so I don't have to, which in turn takes the pressure off of trying to know everything.  There is peace in that.

Certainly more to come soon, but that's a happy smattering to start with.  What the biggest surprise will be in another few months time, that'll be an interesting question all over again.

Fledgling Nurse

Whelp, I've been working toward this goal for literal years, walking the path to RN.  Andy and I have been working toward being financially able to make the move, assessing what our best choices were, and determining our most appropriate timings.  It was a lot of calculating, prioritizing, and a fair bit of luck to get to where we were, able to make this kind of leap.  

My view walking into work the other day

And here we are.  This is real.  I have a license and a job in a hospital and a coach and days scheduled and a direct deposit setup completed.  It's strange to me to accept the benefits of the hard work after working toward it for so long.  It's almost like same feeling as a book hangover, that the absence of having something to look forward to, to be working toward, there's a strange void there.  It's time to construct a new goal.  

In the meanwhile, my goal is to absorb as much as I can.  I've learned a LOT as a CNA, regarding how the hospital works in general and how my floor "moves" specifically.  My role and its pace will change--I think probably the most difficult part of that transition might be delegation, figuring out how to best utilize team resources.  

There is so much to learn, but the real trick as I see it is trying to feel out two important things:  my own independence and the balance in transference I feel with my patients.  

Let's dig into those.  

Independence:  I now have the power to administer medications without someone over my shoulder approving them.  There are administrative and procedure powers, sure, but I can give people medications that are within their orders without double-checking each one with another body, allowing me to create a blending between my time schedule,  my judgement, and the verbal contracts I have made with my patients.  I can reach out to their doctor on the patient's behalf with their concerns.  I can ask the client what goals are important to them today and with what I know about their case.  I decide what order to do different tasks.  And yet, there are still places where I need to have my coach present, partly for my own safety and partly as they are gauging where I need additional hands and insight.  This leads to some waiting times, where we have to find a place that lines up between tasks.  In other words, there are places where I am asking a lot of permission that are necessary for a number of reasons, which does then impact how much independence I can grow at once--not a complaint but a recognition of what simply is.  

Transference:  I remember what it was like to be a patient, in very vivid detail in some places and otherwise some important, formative moments.  It is VERY easy for me to see myself in a lot of their situations, to want to fight for them in the way that I wanted people to fight for me.  I now have the power to do some of those facets, but I do not have the time nor resources to be all things to all people.  I can ask the doctor questions; I can encourage the patient to ask questions; I can help connect the patient with different referrals and resources; I cannot, however, take all of their urgency unto myself nor can I be overzealous and take pieces of their autonomy with me.  The solution will be finding balance between hearing the patients' concerns to then turn them into actionable pieces but also not pulling on more empathy than I have available, to ensure that I don't make it personal to me.  I have to be mindful of what and where my boundaries are.  I also need to demonstrate self-compassion in enforcing those boundaries.  

There are many, many other pieces to sort through:  I am finding a groove in some spaces; I am stumbling my way through others; I am adjusting to the crisis that needs addressing, which means I have to re-adjust my whole day; I am providing emotional support, even when I have other tasks that need doing; I am learning that one more thing that was policy that I was hitherto unaware of and adding that to the mental list of things that need attending; I am refining my scripts; I am starting to get to know my teammates.  

And walking around with all of this uncertainty as I do explore these spaces is exhausting and fulfilling and terrifying and encouraging and a number of other adjectives all at once.  

Mindful Exercise

There has been a LOT to process these days.  I'm two and a half weeks deep into my orientation onto the floor now.  Andy's got more than two months under his belt, now, at Rivian, and things are moving incredibly fast in that arena.  Our household is upended in a few ways with these changes, with patterns broken and the discomfort of attempting to reform new ones in the midst of all else, when energy is stretched in new directions and therefore missing in normal spaces.  How we reconnect as household members, how we manage household tasks, how we plan for external connections (spending time with friends and family), how we think about the future, everything has shifted.  

Also, Luna is heartily confused and acting either sullen or clingy as a result, depending on the day.  

At our respective jobs, Andy and I have agreed that we're feeling the weight of uncertainty, that it's difficult to gauge progress so new in these spaces, that there are mistakes and places where our process will be steadily honed, that we are trying to build relationships with team members, and everything hits a bit different as we work through those spaces.  

In preparation for some of these places, I started to design a workout schedule for myself again, specifically getting back into the pool.  I gave up my membership at L.A. Fitness when I started nursing school, figuring I could use the student facilities while I was there...and then there was that whole pandemic thing and I was quite busy in school anyway.  I stuck mostly to Zumba and Yoga from home, and Andy found a Bowflex for a great deal somewhere in the middle there.  But this wasn't a substitute for total immersion.  After I identified the need, I craved that space, teared up at the thought of taking a deep breath, sliding beneath the surface, and exhaling slowly, watching the bubbles rise around my face.  After finals were complete, I set about finding a new gym membership.  

Forever and a year ago, my family went to Four Seasons in town--this steadily became my top choice again, given that any other gym in town only has three lanes open for swimming IF it has a pool at all.  Four Seasons, on the other hand had 200% more, with a six lane pool dedicated to lap swimming alone.  Even at L.A. Fitness, thinking that I would have to depend on someone to understand lane-sharing etiquette was and having to interact with anyone at all when I wanted to simply be was a small but present deterrent.    

So anyway, about swimming.  The South Pool is weirdly nostalgic for me.  I was a part of a swim team there decades ago, I swam there while getting my teaching certificate, and it feels familiar and whole in interesting ways.

The space is designed with intentionality, a standard marking you'll see most anywhere.  The bottom of the pool has a stripe in each lane, so that when you have proper form you can align yourself accordingly, crossed with another black line at both ends to make an elongated capital "i."  The top of the "i" lets you know you've hit the end and the end wall of the pool will also be marked with a line or a plus sign, similarly to help you identify at a glance that you are indeed at the end of the lane.  Above this pool, there are little flags at either end--these are functional and not just for decoration.  The flags and the color of the lane markers change to a solid color at the same place so that someone swimming backstroke can count how many pulls until they reach the wall, to avoid injury or otherwise roll over for a flip-turn at the right moment.  Before a race at a new pool, there will be swimmers testing and recounting what their distance is at this particular pool for exactly this purpose.  I've yet to see a three lane pool bother with these flags, which is problematic because I quite like backstroke and prefer not to worry about smacking into the wall at speed because I misjudged what part of the ceiling was my pretend marker or lost speed too early because I was concerned it was coming up.  

I'm back in the pool now, and I feel a bit more whole for it.  I missed that part of me.  I missed that particular quiet.  To know that I had a space where the only thing I could do for that period of time was be in the water, to not have access to screens, to feel the wake of my own turn, even to shake water out of my ears when I was done.  It was good for my heart in more than one way to get back to lap swimming.

Once I am past the warm-up, I can usually let my mind wander a bit, aside from counting the lengths to ensure I hit my mile.  Recently, I was thinking about the breast stroke.  Breast stroke is an exercise in mindfulness.

Every stroke is made of a kick, a pull, and a glide.  The breast stroke (above) has a very pronounced glide stage.  The timing happens in such a way that the arms are streamlining the body in front, to get the full benefit of the kick, aiming for a balanced between getting the full benefit of the glide and interrupting it for the next pull and kick to go again.  The whole process, though, is initiated by a breath.  The breath is the action that starts the pull; the head is back in the water and realigning for the full force of the kick; the process starts again with the next breath.  Training your breathing is an important part of all swimming--prevents that whole drowning thing--but in the case of breast stroke, the stroke molds more to your breathing rather than the other way around.    

Again, breast stroke is an exercise in mindfulness as much as it is an exercise for the body.  A steady pattern of breathing.  A constant, required rest period in the glide.  General awareness in the alignment of your body for optimum gliding.  Going somewhere simply for the sake of moving and the benefit of one's heart.  It's about being present in the space, watching the bottom stripe of the pool progress forward in the glide stages, glancing up the for end stripe in the breath, and then back to the bottom black stripe, being only where you are if only for that moment.  

Perhaps that was what I needed more than anything, a way that I could only be present in the moment, forced to be free from any outside distractions and only able to quietly entertain my own thoughts for a while.  Silence, accompanied by the occasional song in my head or the sound of water rushing past my ears.  Only me.  Not me and a running YouTube video.  Just me and the water.  

My rotator cuffs are pretty tender and I'm sore in a couple of places today, but I desperately need these spaces of reconnection, which also happens to coincide with excellent cardio activity.  Definitely not back to my more "regular" mile times (when I was going three times a week), but my body is beginning to remember again, remember the space and the practice, embracing those spaces if only for fifty minutes at a time.  

It's a holy place.  It's a place where I do something purely for myself.  It's a place where I'm conditioned to listen to my body and be aware of how it moves in space.  It's exactly what I need these days.  

Trauma-Informed Thinking

So, I'm not a therapist, but I do delight in sharing the new things I have learned in therapy, the psychoeducation component of those sessions.  This is an invaluable part to my care, to understand and learn more about my condition and my situation through that professional, unbiased perspective while also learning the right vocabulary and names for different elements.  It's how my brain works.  And then I can apply those same concepts elsewhere, drawing further connections and ultimately reframing parts of my understanding into a healthier structure.  

In other words, I enjoy exploring concepts discussed in therapy to further my own understanding of myself and patterns that I also see in others.  And my blog is a safe space where I have enjoyed these explorations.  

So today, I want to talk about trauma-informed thinking.  I knew that one of the angles my therapist employs is CBT, Cognitive Behavioral Therapy, but I confess that I didn't really know what that meant until I was further in my Mental Health and Psychiatric Nursing class this term.  Essentially, how we think about things informs our behavior and sometimes those patterns become "programmed" in ways that need "reprogramming."  For example, someone that is highly anxious might assume that someone is canceling plans on them because the other body is angry with them--there are many reasons why someone changes plans, but the programming does not allow the individual to consider the other reasons in that moment.  Sometimes, we need another perspective to point out the other options.  

In my case, I have a fair bit of fear regarding planning for when (not "if") my body breaks down again and guarding my body from potential concerns.  This means that when I'm considering, say, taking a trip, I'm running a complex risk/benefit analysis first before being excited about the trip, considering the nearest hospital and what my insurance might cover before whether I want to go snorkeling on the first or third day.  Sucks some of the fun out of it straight away.  Or when I'm thinking about leaving a good job to start nursing school (*cough*), there's the question about what kind of security blankets I will have in place (building up the HSA fund, specifically) before things like applications and transcripts.  This can also be a freeze response in situations that "normal" persons wouldn't have a freeze response, such as when a dog jumps up and places their paws on my abdomen, only a few layers between their nails and my intestines.  

The look of a potential threat

Sometimes these pathways are very much something that I have to do, that I have to advocate for myself and know what tools I have.  Other times, it's excess worry and grief or other cognitive pathways that I don't need to go down.  In either case, I recognize that some of these first impulses are trauma-informed thinking.  The trauma that I have gone through frames how I respond and think about certain spaces.  It's not always a "logical" response or a "normal" first response, but it is a response that has been trained at least tangentially from a specific traumatic experience.  

When I encounter a reaction from myself that seems off for whatever reason--based on my own discomfort or the apparent discomfort of someone else--I am practicing to pause and run a systems check:  "is this a reasonable response or a trauma-generated response?"  That systems check gets faster the more practice I put in it, but that doesn't mean it's always a quick answer.  The real trick, though, is not judging the answer.  Both answers are valid--my feelings in those spaces are valid--and now I have a better idea of how to go about resolving the issue.

There are some cases where I can see the same process happening in someone else, noticing a particular reaction and thinking, "I bet there's some conditioning/history there."  This isn't always the case--everyone's brains work a little differently--but at the least it's a moment where I can pause and explore with the individual what's happening for them, to seek clarity or make space where it may be needed.  

Awareness builds intentionally.  Running a systems check at different intervals in the day has been a great first step for me, to keep asking myself those questions even when things are going "well."  It's revealing over time to attempt to reconstruct how and why one thinks the way they think.  I'll never get to the bottom of it, but I will at least start to understand patterns given enough time. 

The Organ Recital

When I was at my lower points of illness, when sitting up in the chair for a while was enough to send my heart rate thumping like I was swimming a mile, there were many, many points where I was frustrated with how weak my body was.  When I was twelve, when I was eighteen, when I was twenty-one, when I was twenty-five, all flares had moments where I felt betrayed by my body--someone that age wasn't supposed to be like this.  

I found at different aspects of recovery from each flare, each surgical step, that later I could sit and hear the symmetry of frustrations from an elderly companion, someone recognizing that their body simply wasn't what it used to be.  A significant difference between my companion and myself was that it was possible and even likely that their body wasn't going to get back to the place it once was ever again while for me there was a lot of unknowns to sift through yet.  Even though I had a different level of optimism about my day-to-day condition, there were no guarantees, but I could still empathize with what we were both feeling in the moment.  

I still remember those places, even now when I'm in the best health I have been in ages.  And I remember the feeling of some of those conversations, to talk with someone that understood.  These tended to happen frequently at church, but also with some older family members.  We were talking frankly about our bodies--frank in our realities and honest in our complaints.  We both gave and took space.  We talked about poop; we talked about aches; we talked about stiffness; we talked about how much endurance we had for "normal" tasks; we talked about ways we had to adapt those tasks; we talked about how not everyone would allow us to talk about these things, interrupting with well-meant comments that shut down their concerns without much empathy.  

Once, I left one of these conversations and a family member asked me how the organ recital was.  When I asked for clarification, they said something along the lines of "oh, you know, my back, my stomach, my kidneys, my eyes...an organ recital."  And, yes, I think that it's an apt name for that kind of conversation.  

And thinking about it, I've experienced the organ recital in multiple ways:

1. As a child, confused but politely listening
2. As an older child, starting to get the idea that some of these things were not normally talked about in other places, but I had been in the hospital and sort of understood that frustration.
3. Acknowledging that this wasn't always a socially acceptable to continue on for long, the incorrect yet also honest answer to "how are you?" but listening politely anyway.
4. Needing to make my own organ recital because that was what was real to me when I was really sick and I fully understood the need for freedom to discuss it and feel heard.
5. Responding with empathy statements, remembering when that need was urgent and allowing them that space, regardless of social acceptability.  
6. Working in a hospital, it is FAR more acceptable to talk about these things, but that doesn't mean that everyone is practiced at it.  Sometimes, I help guide the speaker on how to talk about it with questions and encouraging their own expression.  Sometimes, I briefly mention that I have my own chronic illness, just so they don't have to re-lay the basic groundwork and can jump right to their specifics.  

Having my own experiences with a chronic illness helps me understand the weight of a new, devastating diagnosis.  I won't say that I know all of what their path has in front of them, but I know what it is to have that sense of security in tomorrow shattered.  Having my own experiences in the hospital helps me relate to patients that there currently.  I won't say that I understand their full circumstances and context, but I know enough to relate to the uncertainty and disruption in their lives.  Having a chronic illness has helped me identify with people who are aging, persons who are seeing their bodies slow.  I won't say that it gives me a full understanding, but there is still some commonality of understanding.  

The sound is similar--a genre that I know--but everyone's song is wholly their own.  The real trick is finding a space to play.  As I'm getting ready for work, I sometimes find myself looking forward to hearing another organ recital, partly because I need to know that information to help their care but also that I want to ensure that they have space where they might need it or where I could create it on their behalf.  It's an art.  And particularly with COVID restrictions on visitors, I get the feeling that patients are hungry for that space.  It can be exhausting but also very rewarding.  

The hospital creates a place where we can circumvent the normal taboo.  Advanced age creates a space, too, where we can more readily accept a dump of personal information, be it body mechanical or body emotional.  There are reasons not to talk about certain topics, such as a lack of consent, but a social taboo isn't a good enough reason to refrain from saying things that need to be said.  There's a greater need for these authentic spaces, to create them and to exist in them.  An organ recital can be a holy thing.  Connecting with other people in an authentic space, that's worth far more than preserving certain social rules.

Carrying Secrets

So, Andy is settling into his job at Rivian, and comes home frequently buzzing with excitement.  We'll catch up at the end of the day and he lights up starting to talk about something, and then stops himself.  There are a number of things, he explains, that he's not supposed to tell anyone.  And he does stop.  But I can see that he definitely still wants to talk about it, a quiet buzzing under the skin.  

This hadn't really been a problem before.  When we were both working at Skyward, we knew upcoming developments and changes together or we could otherwise update the other with a mutual understanding--not being public with sensitive information, knowing roughly where that line was, and able to at least talk about any and all scuttlebutt between the two of us.  

However, he's not the only one:  I have secrets, too.  Or rather, I've had them since I've been in clinicals.  I can't go into certain specifics about my day.  I can't share information about my patients that could link back to them.  I can talk about fascinating symptoms in the vaguest sense only.  I cannot geek out about some things until I have enough patient experiences to make up a aggregate "I had a patient once that..."  I am legally bound to keep the information of the patients on my floor.  

(Quick, relevant reminder to today's world:  HIPAA means that as a provider I cannot share your information, not that no one can ask me about mine.)

I hold secrets.  It is a privilege, and it is heavy.  And Andy and I have to adjust to our own mutual circumstances in this.  We both hold different secrets.  We are bound to that secrecy for our respective company's benefit and in my case for the privacy of the patients I serve.  While we recognize that necessity, there's still pressure, the wanting to talk about it.  That means that there is a bit of a disconnect, then, between us.  A minor wall.  It will take some time to sort out how we balance in those places.  

And the goal will not be to eliminate the secrecy but instead to rebalance how we carry those emotional loads and rebalance what it means to our connection.  We can distill out the core of the important pieces that we do need to talk about and can share, yet that will require some additional emotional work to get it to that point, which also needs to fit into that recalibration.  And in time we'll find a pattern in how best to carry pieces forward.  

Revenge of the Blog (Peterson Family Update#3456)

There are lots of big and little things happening in the world, and on a local level there are definitely a number of pieces that make up our home's bigger whole.  

• I'm still adjusting to the idea that I'm not just on a break between the last term and the next--I'm starting to believe it some mornings.  There's still a niggling feeling sometimes that I should be getting back to my textbook readings, but I am steadily moving away from that particular kind of "you need to be productive!" guilt.  
• Luna is, I think, heartily confused by our new schedule.  Andy is gone on weekdays for the workday.  Mike is gone for chunks at a time on multiple days.  I am gone for less days but for a long time on those days.  We're trying to work on some habits and concepts, like how alone time in the kitchen isn't a punishment.  

• One of the last major sections discussed in one of my final courses was all about sepsis.  These sections were very difficult for me to read and process, because it put me back in those memories--all of these facets felt very familiar in some ways.  I had names and patterns for flashes of moments that pieced together into a very horrific whole, blandly stated on a textbook page.  We had a guest speaker come in that voiced her own experience in septic shock, and, while I was grateful for her voice, I also felt trapped in the class, frankly tried to think about something else for parts of it, where I needed a brief gulp of free air.  It fit in with the Seeking the Edges concept, but it was more difficult in that I didn't feel I had much choice in how/when I interacted with it, meaning that it was not my favorite couple of weeks in class.
• By the way, in case folks hadn't seen:  I PASSED MY NCLEX.  It shut off after 75 questions (the minimum, meaning I either did really well or failed it wretchedly), and I tried the trick to re-sign up, got the good pop-up.  Such a relief to have that squared away.  The ball is rolling at Bromenn, to change me over from Tech to RN in the system, work through what orientation pieces I will need and which ones I already have completed.  I got my letter affirming that I had passed and sent it back with a check to the state for my license on Saturday.  Starting to feel like a big kid.  :)  

Real picture of me in the coming weeks

• We had some nursing students on the floor lately during one of my shifts, and that day they were specifically assigned to follow a tech.  I delighted in showing my two persons around and having them try some different things with me, talking about their current course load, the NCLEX, and other random questions as they had them.  
• Andy's new job at Rivian is going well--he comes home full of excitement or tired from being excited most of the day.  There's a lot moving and shaking that he cannot get into the specifics of, but there are many, many good indicators for the company culture.  I'm excited to see how it will steadily affect the area.  
• Switching jobs meant switching insurances.  Rivian's options were much better for our situation (let's be honest, I'm an outlier in most hypotheticals in this arena) than what Carle Bromenn offered, too, which meant that all of the initial pieces for myself had to go through Andy.  And, of course, I had a couple of significant things coming up in August that had specific requirements and necessary gates to go through.  Ugh.  These had to be redone, and within roughly twelve business days.  Effectively we'll be hitting our max out-of-pocket twice within six months, since it will all start over again in January.  *sigh*  
• Andy added about six trees to our yard over the summer.  This is not to mention all of the many other small plants that were also planted around the house.  I hope spring is going to be as pretty as he imagines it!
• Now that we're on the horizon of being a dual income home again, we are starting to think about what our priorities are, for housing projects, financial goals, and what kind of adventures we want in the future.  I want to travel to Iceland late next year, for example.  There are a number of things that we cannot hash out until we have some of the basic numbers sorted out, what my general paycheck range will actually math out to be instead of what I'm guessing it might, but we can at least start some of the speculation phase.  There's hope in those spaces.  
• We're on the precipice of great change in our home, just waiting for a number of things to settle.  There are logistics and emotional facets to consider that we do not yet have enough understanding to work through yet.  We just need to ride the wave for a while.  

More adventures ahead!