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.