I am...

That's a pretty powerful opening to a statement!

It is a declaration.  An introduction.  A first, and more importantly, a lasting impression.

Conjugations and past participles aside... it is a phrase that one personally uses to describe themselves, therefore a declaration to those who would not only hear, yet listen...

I am, I was, I used to be, I want to be, I wanted to be, I will be, I could have been, I should have been...






I have heard even more powerful statements, though...

He is, she is, they are, we are, this is...


I know who I am.

Merry Christmas!

One of the hardest lessons I have had to learn, is that pain, destruction, and fear are the things that offer each of us, the most opportunity to grow!  It is up to the individual, to choose to learn from the experience!

I can retreat, run away, hide... my life so far, has afforded me these options!

Yet, I choose not to.

Some will argue that I have actually retreated, run away, and have hidden.  To them, I offer an invitation to tag along with me!  A "walk in my shoes" thing...

Saddle up!  We have a ride!  One stop, then a welcome!  Dare to come with me???

The bottom line?  My time is limited.  I accept this.  A greater good?  Probably.  I am here... might as well make the best of it!

Vanquish a few fears, witness for some, presence for others.  Comfort.  Solace.  Agreement.  Understanding.  Trust.

If still unconvinced, in three or four days, I take this ride.  I welcome any who wish to join me!  I-10/SR85/I-8... if you travel, and see the nomad...  pull in behind... turn on the brights... then pass, and clear the road ahead...

Be sure to speed, yet only 5mph over!  I cruise at 80!  That makes passing difficult... a paradox...  yours to solve!

SPAM!

It comes in many forms.

Email is the most known.

Monty Python is the lesser.

I lean towards the Monty Python experience!


A single can, with adequate water supply, can sustain an individual for a week... a lot of salt...  Dihydrogenoxidase, is the equalizer!


Merry Christmas!

A simple request...

The depths of human strength, to endure such suffering, is unfathomable... I have seen it in history, recently, witnessed it for myself.

Abuela, usted es un pilar! Lamento haberte causado molestias usted, estoy feliz que era capaz de aliviar su dolor. Disfrute del café ... el médico no sabía!

The best of times, the worst of times...

I think of myself, and have been described as, a no-nonsense type of person.  In other words, save the bullshit, what is it that needs to be done?

As an experienced individual, I find that when people are left to there own... they either rise, sink, or just float along.  There are some that might need a boost, or a lift at times; and then there are some that need a reality check, or at least the chair knocked out from under them, every now and then...

I admit, I myself, am not immune.  Throughout my life, I've had a few hands up, a chair or two knocked out, and quite a few 2x4's up side the head, if I may say so.




This past week has been interesting.  I wouldn't call it a personal conflict, yet I have been "bumping heads," with another individual quite often.  I macro-manage, focusing when needed.  This individual tends to micro-manage, looking up and around when they need to get their bearings.

The other day, this individual found themselves as a peer to me.

Their assignment:  Two discharges, an admit, and a new patient via ambulance all at the same time.  Trying to call report on the admit, one of the discharges standing in the hallway demanding that the IV (at least I think that was what they were referring to as the "damn thing") out of their arm, and the disparate look on my peer's face as the ambulance stretcher wheeled into their only open room...

I chuckled.  Thought about just walking by, as I knew they would not ask for help just to prove they could handle it.  Yet, I am able to rise above the petty stuff, cut through the BS, and just get what needs to be done, done.  So I took out the offending IV. Then went to the new patient.  Intake, assessment, and initial interventions completed.

One discharge left without instructions, the admit was on the way to floor, the other discharge due to a condition change, now an admission...  When they finally got to the new patient... I calmly gave report.  Everything was done, awaiting the physician.  As I left, I heard a soft-spoken, "Thanks."  I turned, smiled, and said, "I'm a Nurse too, it's what we do.  You're welcome."

Not a 2x4, nor a chair knocked out from under them, a gentle reminder.

Joy

Tis the Season...

I was asked to provide input.  What brings you joy? How is that joy reflected in your words and actions?

I responded.

Yet the answer was interesting.

'An open road, a destination or not, and a purpose, is what brings me joy.'

However, my words and actions, would probably offend most, most of the time.  Yet, for the one that I am present for...


I can not connect true joy with offending someone.

I will give someone a sandwich, as fast as I send them to jail.  Cross me, and I will walk away.  Push me, and you will feel wrath.  Yet, I will still be the the first one to defend you, and the last to witness.

Best friend, or worst enemy?

My Joy?  Well, it is, deferred.

Layers...

Been gone for a week, working, semi-disconnected...  used my handheld computer device that also seems to have a phone function (who knew!?), to check in every now and then...

Sort of refreshing, in a way.

It is an interesting study; that is, how people connect and/or keep in touch.  Then there are the layers of interaction...


For me, when I hear someone mention "layers," I think 'clothing.'  It was 64 degrees outside as I was departing my locale.  It dropped into the mid-50's during my journey.  Speeds of 80 mph... that's a "feels like" of 45 degrees.  Crosswinds of 9 mph with gusts... ends up being a little lower...

I got as far as Gila Bend.

After an hour and a half of riding, the last ten minutes, I began to shiver. 

Tank topped off, I went inside the store, used the facilities, bought a coffee, announced, and asked if I could stay inside, near the door and just warm up a bit.  The clerk recognized me, probably from my frequent visits, and graciously allowed my request.

As I prepared for my departure, the final leg of my trip, I added a few layers.  The outermost being my leather.  Wonderful and miraculous material, truly a God-given gift!

The more layers I had, the warmer I became... 

and that is something to think about.

Happy Thanksgiving!

This morning, I will commute.  A ride of ~3 hours, several hundred miles.

I join with several other people that will be traveling!  Be aware, and stay safe!

Regulars...

As in customers.  Like a person who comes in every morning to the coffee shop and orders the same thing, day after day...

Every once and a while, they mix things up, and occasionally, they add some spice... regardless, they will be back.

So tomorrow, the sun will rise, the day will progress, people will do, and the sun will set...  then, the night shift begins!

Warmth

Heater finally kicked on the other night.  Had it set at 75 degrees.

So I turned it down to 70, and pulled out a blanket.


Kicked on again tonight.  Granted, it is cool outside right now, mid 40's...

I am going to turn it down again, to 65.




The nice thing about working with wool yarn on a project... one gets to enjoy the insulative properties during the manufacture...  It is that warmth, that is somehow passed into the piece.

The first day of relief!

Last night was pretty ruff!  This morning was almost unbearable!

After a 20 minute "hot" shower this morning... I finally was able to take a deep breath!  Wonder what my gas bill will be!?  As I am sure I drained the hot water heater!

I am over the hump on my URI.  All of the colors, except the ominous one! 

It has been about 6 hours, since I have had the need for facial tissue!  Still the occasional cough though...

Seeing as I had this seasons flu-shot, I hope this was either a mediated response, or boost to my natural immune system for a different bug!  Let's hope the rest of the season goes by without incident!

Family time tomorrow!

Friends time in a couple of days!


Remember, don't just look... see!

URI...

Upper Respiratory Infection!

Been dealing with it for the past two days.  If civilian medical workers could earn the Purple Heart...

What's interesting, is that I know exactly which patient passed it on to me.  Nothing short of full isolation precautions would have prevented me from acquiring said "bug." 

The need for human contact, a touch, a hold, and a little bounce in the arms... outweighed the risk.  After all, I was just responsible for imposing a urinary catheterization, two nasal swabs, and a needle... 

I did get a smile and a wave when the patient was discharged.  Somehow, I think they knew that even though I caused discomfort and pain, I was there to help them... either that or the Ibuprofen kicked in.


Peace!

No helmet!

A few miles away, off of 8th Street...

an abandoned spur.

Past the canal, the verdant, lush zone... is the Colorado River.  Beyond that, is the Southern part of Algondonas, MX.

No bullet holes!

A few miles down the road, I saw this...

the "Fence," with a gate...

and they have instructions/warnings about opening and closing the gate!

I wonder where that electricity goes?

North:

South:

Obviously, I am West of the canal, still East of the Colorado River.

My wanderings passed through Somerton, and eventually to San Luis.   I parked my bike and freely walked across the border into Mexico.  Walked around, even shopped.  Tried to buy a pair of boots, the store owner even left and went up the street, was actually gone for 5 minutes, going store to store, trying to find my size!  No luck.  Guess WalMart once again will make a sale.

Looked for a place to stop...

It was closed.

So I ventured back to the US.

There was a line.  Three people in front of me, was a man who was arrested!  Handcuffed and escorted away...

Almost an hour later, I presented my US Passport, and was grilled!  Why did I go to Mexico, how many times have I been to Mexico, when was the last time I have been to Mexico, what was the purpose of my trip, do I have any firearms, illegal drugs, where is your car... Was asked for 'secondary ID!'  Really!  That was a US Passport, with my picture on it, issued by the US Government!

I smiled, was friendly, actually it turned into a conversation about bikes!  Seems the CBP Officer also was a rider.  Held up the line a bit! 

And no, I did not drink the water... Boobies was closed after all.

A ride?

Today!  A full day off!

Not a commute, just me, my bike, and nowhere to be!

There is a somewhere however... and I will be there!

Better bring my helmet...  California is a possibility... then again, less than 5 hour to Nevada... although I will still need my helmet.

Some sage advice...

The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.

Just saying...

Before you approach a stranger at a gas pump, asking for change...

First and foremost, be sober and alert enough to realize who and what you are approaching!

Second, have enough sense to remove the EKG electrodes from your chest and hospital ID armband from your wrist.

Third, tell the truth, not some lame, made up story!

Wants versus needs...

Still here!

Been a busy week, to say the least!

Family, friends, work...

It still amazes me how much occurs in a single day, let alone in a week.

Be back soon, need this day(night) off!


Peace!

Great couple of days...

Got home on Sunday, met up with a neighbor/friend and had dinner.

Monday, met my parents for lunch.

Today, lunch and an afternoon with a friend, a fellow rider and nurse; and his new wife.

Friends, family, and neighbors!



Tomorrow, I take a ride...

The end of a week.

I am slowly working into a specific schedule.  My preference is a six on/eight off.  A "super-weekend," schedule, where I work Thursday thru Tuesday.  Work a week, have a week off.  When I work the week, I accomplish two weeks of work.  It is amazing what one can accomplish, visit, do in eight days!

So far, since my start, I have been on a set schedule, three days a week, set, consecutive days.  Gives me four days off in a row.  For the past two weeks, I have "picked up" extra, trying to get a few hours of OT.  Yet I have been "low-censused," that is, been sent home early a few days, effectively negating the OT.

Fool me once, shame on me... fool me twice, shame on you!

Which got me thinking...

A little over a year ago, I experienced one of the greatest things!  I was riding to Yuma early in the morning, and witnessed a sunrise, via my rear-view mirrors.  It was fabulous, and inspiring!  I have a post about that if you want to look back.

About four months later, I was humbled, and spent a night a mere 70 miles from home, as I had not taken into account ambient air temperatures, ~80mph winds (adjusted wind/riding speeds), and the subsequent wind-chill factor. 

A mere six months later, I left mid-afternoon and literally sun-gazed for about two hours!  When one sees the red-reflectors of the lane markers on a divided highway, in a rear view mirror, I strongly suggest just pulling over.  It's not worth it.  A lot of concentration to just maintain lane position, and one of the few times I drafted on a semi, to provide a little shade in trade for lower speeds and a little turbulence...  hints at how close I had to be...

So, one more shift, then a ride home for a few days.  A few appointments, meetings, bills to pay, mail to check, cleaning to do, connections to make...

Then, a renewal.  Interesting, if you think about it.  Perhaps, I will share the ingredients of the "B-52," for my non-nursing followers... as I had to administer it twice in the past week!


Peace!

Distractions...

A double edged sword!

Everyone has experienced at least one distraction in their life.  Most a few, some many.

Being distracted is not always a bad thing.  It is through distraction, that is taking focus off of a topic of interest, that some of the greatest ideas, discoveries, and inventions to date, have occurred.

"Oh... look here!  Shiny sparkly thingy!"
      Really!?  Where?  Ahhh...



Hence, cold fusion is impossible; as the mass necessary to create the compression and pressure necessary to fuse two distinct atoms together into one, has such an exothermic discharge that it creates both light and heat.

Even "cold" stars, are incredibly hot, with temperatures measured on the Kelvin Scale.

Now that you have just read and thought about that for a second...

Life is pretty simple.  One is born, and then eventually, one dies.  I know that sounds harsh, yet it is reality.  What one does, in the "between"... well that is their own personal journey.  Sometimes shared, sometimes accompanied, sometimes kept private.

Distractions in life, is the core determinate of experience. 

Imagine (a purposeful distraction this time) for a moment, if on the day you were born, you knew and understood that you would eventually die.  How would your life have been different?  As of today, right now, this instant, as you are reading this, would you have done anything different?  Taken more, or perhaps less, risks?

The child who hears a pianist play Mozart, someone who looks through a telescope and sees the rings of Saturn, a person that realizes a new use for an existing thing...

It all comes together.  The experience, albeit full of distractions, is life!

I understand that sounds circular, yet ponder this...

The distractions of a seven year old boy, led to a career choice.  And after 27+ years into the career, that little boy, has affected more lives than most will ever meet!

Family and friends are important.  It is the stranger that often means the most.  A distraction from the eventuality.  Even when, the eventuality is occurring for the stranger...

I am humbled, and honored.

Simplicity

My family has experienced a few 'bumps' lately.

I have found myself texting, emailing, and FB msg'ing an extraordinary amount lately.  Which is not my nature.

So, I stated my thoughts in a short and succinct manner, and thought that was to be the end of it.  I received a long response in return.  I almost ignored it, yet I responded none the less... in an even shorter and more succinct manner.  Was I baited?  Did I nibble?  Perhaps.  Shame on me. 

Yet, today I received a text from a friend asking me two questions.  I not only responded, I actually called them to discuss the questions, the situation in which they arose, and proffered my input.

As an Emergency Nurse, I have come to the understanding that what a patient tells the Triage Nurse, is different from what they tell me, which is again different from what they tell the physician.  Same person, one motive, three different explanations/stories.

Life is simple.  Wake up, do, interact, sleep, repeat until death.  Oh, and eat every now and then!

Wants vs. Needs

A few days ago, I was talking with another Travel Nurse.  They wanted to know how I could travel, take a contract, and bring everything I needed on a bike.  Seems their car was stuffed and filled to the brim.

I chuckled.

The explanation that followed, was about minimalism.  Three shifts, four pairs of scrubs (just in case).  Appropriate amount of undergarments.  Purchase needed accessories/toiletries upon arrival.  One can buy a razor, deodorant, shoes, etc.  No need to haul it with you.  And donate anything left over when you leave.

Now I admit, I come and go.  So it is easier for me than someone who came from across the country and will be somewhere for a minimum of three months.  Yet, the principles still apply. 

Today, I learned that the facility I am at, has already requested to renew/extend my contract... a mere two weeks into it.  Humbling, to say the least.

This made me think.  I have certain things that I need to survive.  I also have wants.  Yet my number one want... is to have my needs met.

That, is the difference.

Carne Asada

Yesterday, I returned home for the first time in two weeks.  I started a new contract and between "orientation" and the first week of working, I stayed. 

As evening approached, my downstairs neighbors began grilling... the sweet smell of steak... ahhh

Now my next door neighbors are either friends or family to those below.  I know my next door neighbors better than my downstairs.  As I walked down to retrieve 2 weeks worth of mail, mostly junk by the way, I came back up, and was invited to share in their meal.

Carne asada, rice, beans, homemade tortillas, and salsa.  It was delicious!  We talked, shared, and I even learned a little more Spanish.

A pause...

A little over a month ago, I finished a contract in Tucson.  There were a series of events that made me take pause.  I actually took a full month off, in order to consider and think about things.

I eventually came to the realization that I am who I am and do what I do.  There is really nothing else I would want to do.  And, quite frankly, I am getting a little too old to change careers now...

So, I effectively hit the reset button.

I have just completed my first week on a new contract, in a familiar place.  I was surprised by the recognition, enthusiasm, and welcome when I returned!  Although it has been six months, it feels like it was only yesterday.  A few changes... yet that is the only thing constant in life... change!

My career has changed, however!  I am no longer a Health Care provider...  I am now a Medical Care worker.

I'll pause, and let that sink in.

Cooking

I can vaguely remember the first time I cooked.  It was more than following a recipe, you see I made it my own... I added hot dogs.

I really learned to cook when I was a firefighter.  The newbie, given the low-end jobs like cleaning bathrooms, rolling hoses, occasionally tested every now and then.  On a crawler, greasing axles more than once, running a few calls by myself, eventually the responsibility of both a truck and another person...

That's when I grew-up.

My epiphany came when I was almost cooked myself.  A brush-fire.  I knew the strategy and tactics needed.  When I was ordered to do something outside of it, I originally thought, OK.  Maybe there is more that I need to learn.  That day was the first day I ever truly saved a life, as I yelled at the reserve firefighter with me, to run.  We both hurdled that three foot high barbed-wire fence...

Chili, chicken cacciatore, ribs, casseroles, posole...  The difference between low and slow vs. hot and fast...  cooking, not preparing.

It has been an interesting journey to say the least!

I saw it again a week ago at a family picnic.

The one person, who seemed adamant that they would not cook... ended up cooking.  I sat there and smiled.  I did give a jab... and that caused a few more people to smile.

The one thing I miss, is that lately... I boil water, at most open a can.  The last time I cooked, it seemed like it was a never ending event,  A simple get-together with a few friends, ended up turning into a neighborhood event.  We started early, and were serving food by 4pm.  People kept coming, food kept arriving, soon we were inviting and asking people just walking by to join us. 

The secret?  Well, if you know, a 'wink' to you.  If you don't, a simple handshake will do...

Question of purpose...

About a month ago, I asked myself a question.  I still haven't heard, that is, answered, myself, yet...

There was a time that I was outspoken, opinionated, and downright argumentative.  I still speak, have an opinion, and still enjoy a good and fair discussion.

However, one of the most powerful things an individual has, is silence. 

It accomplishes a number of things!  The most important, is that it enables one to not only listen, yet hear as well.  When one hears, they begin to understand.  When one understands, they begin to see.  When one sees, they begin to know.

A lesson learned and remembered.

Perspectives

Most people tend to think in three or four dimensions.  Up, down, right, left, forward, back... describe any point in space by coordinates, you know, the x, y, and z axis.  And a diagonal movement, is moving in multiple directions equally and simultaneously, at exactly the same time.  Which illustrates the fourth.

It all can be explained by perspective.  If I were to move in a certain direction, I perceive myself as doing nothing but moving forward.  You, however, may perceive me moving forward and to the right, based on your perspective.  Yet, in my reality, I am moving down, to the right, and backward all at the same time, from the point of common origin.

See the conundrum?

I was recently asked a question.  As I started to answer it, I was interrupted and told my response should be a simple "yes or no."  So I answered in the binary way the person was requesting.

It seems my answer, caused a few more questions in my inquisitors mind... 

Peace!

In the eye of the beholder...

This is my opinion and thoughts.

The world is about to lose a very talented artist.  An individual, who has little recognition.  Yet the work I was allowed to see, totally awe inspiring!

It pains me.

Now each individual has their own opinion of art, design, and creativity.  Obviously, my taste, is not your taste.  However, I saw some of the most dramatic geometrical paintings, an abstract that had subtlety, and the pen and ink... unbelievable!

I was humbled, when I was given an A/P of one of the pen and inks.

Most people choose to see, hear, and think what they want to.  A few people choose to look, listen, and understand what is.

Man in the Moon!

I went outside, and saw it!

Also, Altair, Vega, and could just make out Neptune as well!  If I am still awake later, might try to find Uranus.  Moon was too bright, along with the city lights to see much more at the time, just a few spots of light here and there.

Makes one feel small really... 

An alignment of the Sun, Earth, and Moon, which brings a certain phase.  The shadows on the Moon's craters, cast by the Sun, almost halfway around the world at the time... causes a view that creates an oblong shape, with an impression (view, what is seen) of a face!  Eyes, nose, mouth...

A face on the Moon... of a man.


Peace.

The other night, I met another Angel!

A concerned neighbor checked on my activity in the building's storeroom.  As it was me doing the activity, I was curtly reminded to make sure I lock the door, to which I replied equally as curtly, "I will."

Less than 15 minutes later, I found myself sitting on the steps, talking with this same individual.  Who quickly became a friend, who somehow, reminded me of myself so much... I actually thought I was talking to myself.  Over an hour and a half.  Other neighbors came and went, always walking around us... as we were blocking the pathway/stairs.

A man, 60-ish, behind on rent and a few other bills, about to have eviction proceedings initiated.  Asked me if I needed some furniture.  He was in the medical field, although not a Nurse.  Similar life story though.  I listened to his story.  The struggles and the problems.  I asked questions.  Received his answers.

It was as we were parting, that I... well, it suddenly struck me.

Angels...

This morning, a bittersweet moment.  I left a place I have been for the last 6 months.  As I turned in the key, asked for another 30 minutes to finish loading... I thought to myself, "You packed yesterday, and awoke and loaded before the alarm went off this morning!  Why the delay?"

Well, two reasons.  First, I wanted to see the ending of a movie I had been watching.  Second, it was not yet time for me to leave.

Housekeeping, often leaves room doors open, so as I exited, I left my door open.  Fueled and ready, loaded and secured, jacket on and zipped, a straddle and final helmet and gloves...

I paused.

Got off my bike, walked up and closed my room door.

When I got back on my bike, a butterfly came from my right.  It's erratic flight brought it right it front of me.  For less than second, it alit on the top of my windscreen,  then it flew on.

I smiled, and went on to have one of the best and easiest rides I have ever had.

Almost missed that Angel!

'Hell-banger!'

Today, was a planned departure.  Then, a sudden realization, that I now find myself remaining one more day. More proof towards one of my underlying philosophies... planning, results in heavenly laughter!

Went for a short ride today, which resulted in me racing a storm!  Arrived at my final destination, and then watched and experienced what I call a "hell-banger" of a storm!

Over an hour of heavy rain (door, window, and carpet by the door, on the inside - wet), lightning about every 30 seconds, for a good 5 minutes (closest strike, according to weather resources, ~370 feet away - given GPS error), a few "brown-outs", and 50+ mph gusts for a few minutes (I locked down my bike, yet still saw it rock a little bit...)

The term, "hell-banger" is a result of the thunder, which resulted from the lightning... every 30 to 60 seconds... for a good solid 5 minutes!  Quite an experience actually.  Ranks right up there with having a near lightning strike, which is another story all together, and another post.  The strobe of a flash, followed by another... then the resulting crash, which is still occurring when the 'crack' begins!

I have been asked many questions throughout my life.  Obviously, I have given almost as many answers.  Lately, my favorite type of question starts with, "Did you..."  When asked this type of question, I typically rephrase it into another question, in an attempt to gain clarity as to what is truly being asked.  "Do I..."

I have found that lately, the majority of time, my answer to both forms... are yes.  And that tends to catch a few people off-guard... so to speak.

There is a subtle difference between "hell-raising" and "hell-banging."

So, I change the question!

"Are you..." 

"Am I..."

My answer to your question.

Yes, I know and realize... by just about 2 months.

"Life is a set of sequential events.  It starts well before birth, and ends well after death.  Sometimes we can control the in-between by the choices we make.  Yet, the in-between will still happen." - CFWG

STOP!

Re-read that.

A bit of wisdom.  Somewhat poetic in a way!

A story.

One day, a boy woke up not knowing that it was the day that he would truly become a man.  You see, he felt that he would never grow up, yet had always known he grew up far faster than he should have.  By personal choice.  Exploration, seeking of knowledge, and situations involved.

On this day, by age, he was mature.  I father of two daughters. Married, and divorced, twice.  Educated, schooled... knowledgeable, a mentor, preceptor...  heck, he even chuckled often when he realized that he was old enough to be a parent of some of his co-workers!

So many friends and acquaintances!

He even chuckled again, when he thought of his earlier peers.  How they must have felt the same way about him, as he was now thinking of his.


The constant in all of this, was peers.  Older, middle, younger. 

And to think, it all started in the 1970's... with a cousin that got there before... a flute case and an old telephone handset... a TV show... a gutted BB gun and a broomstick. 

Should this story be told?  It would probably get graphic eventually.  Part of the growing up.  So the answer is, perhaps.  Someday, someone will.


Have I fulfilled my purpose in life?  Probably not, maybe, perhaps.  Not a single person will ever know in their lifetime.

It took less than a decade... that is when it was sealed. 

Now, it has become complete.  There is a contentment that occurs.  A silence descends.  And this alone explains why, one can be stoic. 

As I can attest, there are just some things, one should not share with others.  Yet sometimes... a simple question will open a dialogue.  When a son or daughter does not know something, it is because a parent did not want to expose them to it.  Knowledge is passed, memories are shared, and sometimes, promises are made.

Often generations are passed.

For this, I truly apologize.  A promise was made.

It would be nice to wake up in the morning and stir some coals... add a few chunks of wood... get the fire going again...

And herin lies the crux!

I have read, heard, and been told so many times, that if you don't like/love your job... then quit and do something else.

What about the person who does like/love there job, yet has grown weary.  Not tired, weary.

I have chosen to be enjoined in a war, where battles are measured by 'before,' 'after,' or 'I didn't get a "lunch break"...'  Where patient's are calling me by name when I enter into the room or they see me walking by...  When at the end of a shift, there is often an awkward silence at the timeclock, where a simple nod, or blinking of the eyes, conveys more information than words can ever describe or communicate... 

Lately, I have been at the end of the game.  An argument for becoming a Labor & Delivery Nurse for sure!  Yet my skill set has been more in the rapid focus, assessment, planning, and intervention area.  Not saying that emergencies do not occur during childbirth, after all there are always at least two patient's involved at the exact same time.  Yet I have always said that depending on one's perspective, women having been giving birth for thousands of years or millions of years... modern medicine came around in the last few hundred, and messed it all up.  Then again, the same argument applies to who I am and what I do now...

I guess that explains my lacking.  Follow-through.  I treat or street!  Problem, fix.  One either goes upstairs or is discharged.  I do not claim disability, I wonder/ask, is this an over-simplification versus a true understanding?  It used to be called being an, "adrenalin junkie!"

"Secondary Post Traumatic Stress Disorder," is as foreign to me as being 'allergic' to every available medication except the specific one that is being sought.  Make's for a few raised eyebrows by nurses!

It would be nice to wake up in the morning and stir some coals... add a few chunks of wood... get the fire going again.  Cook breakfast!  Eggs, bacon, biscuits... gravy if there were some pork drippings left over from the night before, with some flour.  The "fancy" name for that now is "Rue."  Always a pot of oats for breakfast!  The secret surprise, is that there is a dutch oven reserved, prepared throughout the day, filled with a cobbler!  Cooked slowly near the end.  Shared only with friends and family.

Which way?

I truly love the decision!

Of course I am biased, as when I turn, there are a few more things I consider.

The least of which, is which direction do I want to go.

One of the greatest things about riding, is that it makes the individual stand straight! 

So if you missed it...

Look up! 

Regardless of your lack of concern, pure stupidity, and reckless abandon... you avoided a motor vehicle accident!

I just turned.

Reckoning...

1. the action or process of calculating or estimating something.

At first I sorta scoffed... I do that everyday, even without trying.  The first touch.

Age is a number, it marks how many years one has been alive.  In reality, it is nothing more than a scale.  A year is made up of months, months weeks, weeks days, days hours, hours minutes, minutes just mere seconds.  Some of the most mature individuals I have ever had the opportunity to meet, have not even reached there 13th birthday.

Then I started to think about my work and all of the decisions I make in a shift.  The second touch.

Given time, everyone will experience the same as I have.  Nothing I do is special.  Birth, injury, illness, death... these are things that everyone deals with in their lifetime!  If anything, I choose to deal with it more acutely and directly.  Perhaps giving some solace to others, who are not yet ready to deal with the immediate.  My solace, is that I have always been present.

I started thinking about my experiences.  The things I have seen, the things I have done.  Places I have gone.  The third touch.  More like a hand on one's shoulder, a gentle squeeze...

I grew up.  And it made me sad. 

It took 45+ years.  The plus is all of the seconds, minutes, hours, days, weeks, and months...

There is no decline forcasted.  Just a graduation to a new understanding.  I will however, reserve the right to reminisce!

Let's take a walk...

As I crawled out of my cave this evening...

Just some random thoughts...


Was pleasantly surprised with a light rain.

My phone however, let me know that there had been severe thunderstorm and flash flood advisories.  A testament to mankind... I slept through the worst of it!  Including those obnoxious alert tones that I need to change one of these days.  Been in a room where suddenly 15+ phones all give off the same alert tone?  And no one has changed it yet?!?!

A short ride to get some sustenance.

The occasional reminder that it was in fact raining.  My worst, and talk about timing, physics, and pure luck... was when I caught a raindrop with my right eye!  Contact lens secure, just a wallop of all wallops! 

I rescued a fellow traveler this evening.  After the fifth time their car alarm went off, I walked outside.  Noticed that the interior lights were on.  Suggested they turn them off and re-arm.  Silence has now returned to my world!

HBO, Discovery, FOX, CNN, History, and Food Network are the staples of hotel cable. 

WARNING:  POLITICAL COMMENT

I channel surf all the time.  The previous named channels are just the ones I seem to land on most of the time.  When I have watched CNN, and they are showing a clip of a FOX story... likewise, when FOX shows a clip of a CNN story... just makes me wonder.  And notice, the Weather was not included!

I have all respect for Senora Jackie, yet your Casa de Waffle picante sauce, tastes like Pace... bought in New York City.

If you want to truly make an impact, affect, and impart an effect...

Fire up a Harley sometime after midnight!!!

You live in the light, I live in the dark.  Welcome...

A cry for help...

There are a few times, when one can make a real difference.

I rarely, if ever have cash, let alone "change" on my person.   A defense mechanism, learned, and applied. 


The other day, I stopped to get fuel.  I was approached and asked for change to "buy gas."  As I had no change, I politely declined the request for assistance.

The individual immediately went to the next vehicle over, and asked again the same question, this time offering to at least grab the gas station's 'island tools' and wash windows... all he asked for was $0.25, to make $4.00, so he could buy a gallon of gas.

This is when I looked over.

A car.  A woman and two children around it.  It was there when I pulled in.  The smallest child was playing.  This made me smile!  As hard as it was for them, this little child found the time to make the best of the situation, and was actually imagining and playing around the gas pump and barriers!  This then made me frown.  How could a parent let their child be exposed to such a dangerous environment and situation! 

Then, as I finished filling up my tank, I noticed and heard the individual, who just approached me asking for assistance, approach almost every other person down the pumps, just asking for a quarter to make an even dollar, to buy a few gallons of gas.  He then went to the big dvd rental box & water filling station to check for change.  All the while, the car and family remained.

I ended up going into the store and bought a few items, and added $20.00 for the gas on pump #14, where the car in question, was parked at. 

As I exited, I walked up to the individual, who was now at the car.

I simply asked, where are you going?

The reply was, "Home.  We just ran out of gas."

As long as this story has been, I will end it quickly!

My reply, "Then go home.  I have no change, yet there is $20.00 on that pump."  I was immediately thanked and offered the $5.25 he had collected so far.  I declined.

Am I a sucker?  Did I play into it?  Perhaps.  If so, he is a better man than me.

A "real" day... of rest!

My shift on Sunday night was nice, relatively easy, only one ICU admit, a few other non-ICU admits, a few discharges, and a whole lot of "hurry up and waiting!"

I guess as a provider, I have a more realistic expectation, perhaps experience, with the whole Emergency Medical process.

When someone is truly life-threatening/critical... a lot of resources are gathered and expended in a very short period of time.  So yes, when a patient is having chest pain, a lot of things are done quickly, and if it is an Acute Myocardial Infarction (heart attack)... one can be in and out of the ED and on their way to the Cardiac Cath lab in about 10 minutes.

In those same initial ten minutes the ED can rule out the life-threatening problem.  Now it becomes a minimum of a four hour rule-out... and even then, one might still get admitted for observation and further non-emergent testing in the morning.

Yet it's not just chest pains.  Breathing problems, headaches, abdominal pain, etc... all of these have potentially life-threatening causes.  The ED has to quickly determine the probable cause and either intervene, or treat and observe.

What truly amazes me, is that someone can be triaged and end up waiting several hours, only to finally get back to a treatment room, and start complaining that they have been here for "8 hours."  A quick check of the computer, and they have only been in the ED for about 5 hours.  I try to explain the process, yet once someone is upset, there is very little one can do sway them. 

I think that the problem is that people think of the Medical System as a Service Industry.  Like going to a restaurant, or getting one's A/C repaired.  TV shows have not helped either, when a show depicts a patient's complaint being tested, diagnosed, and fully treated in a 30-60 minute episode!

Less than 10% of all visits to an ED, are truly life threatening (trauma excluded).

Regardless, I got home this morning, had some dinner, relaxed, watched the news... and finally fell asleep around 9am.  I woke up a full 12 hours later!  Good thing I have tonight off!

Now, what to do tonight... I guess some laundry is in order.

KARMA!

I am a true believer!

Things truly go around!  So some advice... make sure what you put out, is what you want back!

Throughout my life, I have experienced quite a few things.  I have always strived to maintain the highest standards, provide the utmost respect for others, and just dig in and get the job done.

Life is... the best roller-coaster ride ever!


Peace!

Perhaps a year early...

Twenty-nine years ago, I officially began my career.  That was when I received my first State Certification, recognizing me as a Professional.

It does not take into consideration all of the preparation, courses, and classes leading up to it...

A year later, I graduated High School.

In retrospect, I truly embarked on this journey when I was only 7 years old.


I am now, the epitome, of the perfect 'worst' dinner guest!

I have pretty much seen, done, dealt with, handled, been handed, handed to, cleaned-up, wiped, held, cried both for and with, sat with, held hands, answered questions, explained, cared for, pissed off, actually have been pissed on (as well as puked on, shit on, bled on, and other numerous bodily fluids spilled upon), saved, failed, maintained, lost, followed, commanded...

Not to mention that I have fed, bathed, nurtured, medicated, taken down, sent a few to jail, taken care of a family, argued, refused, insisted, inflicted discomfort and pain, relieved just the same, walked away, ran into, stepped in, stepped up, sent others away, gathered some together...

Ask me a question.

I am an Emergency Nurse.


Now, I must prepare.  Sleep, as I return to the battle this night...  I expect I will experience something new.

Presence

I have been present, and witness to, the coming into this world.

I have been present, and witness to, amazing things.

I have been present, and witness to, lives suffering.

I have been present, and witness to, terrible things.

I have been present, and witness to, remarkable things.

I have been present, and witness to, leaving this world.

I have been present, and witness to... well...

The one thing that has been constant?

I have been present, and witnessed.

This time I listened!

Throughout my adult life, one can say I have had a few ups and downs to say the least.  I have learned the hard way, not to ignore those "gentle" nudges, whispers, thoughts...  by that I mean, I have had the nudges, whispers, and thoughts, which I ignored or explained away... only to get a "proverbial" 2x4 up side my head a few times.

So, as I have been thinking about what to do next... two days in a row now, I have received some guidance.  So I made a decision.

There is an open road ahead of me.  Where I end up doesn't matter.  I will enjoy and appreciate the journey!

Divergence...

There is a me me.  And then there is a you me, a them me, and so on, and so on.

Only I know what I am truly thinking and feeling; as for another to know, I must express or communicate a message, that is received and interpreted correctly.

This is one of the hardest things, as an experienced Nurse, that I have struggled with.  Don't get me wrong.  I will fight, argue, stand toe-to-toe, and push myself to physical exhaustion and eventual collapse... when it is warranted, in order to save a life.

I will also do the same, when it is not... and it is best to just let go.

As any student of history knows, battles often turn.  It is a good commander, that realizes that defeat is inevitable, and to spare as many as possible... retreat is often the most prudent action.



So here is my recent experience...

A peer was providing 1:1 care for a critical patient.  I was not involved directly, only providing cross-coverage to their other patients with yet another peer.  After a few hours, they came to me and asked  to help them troubleshoot the Art-Line (arterial line, placed to provide real-time, instant, constant measurement of blood pressure).  It seems that although there was a wave form, there was no numerical reading.

I went through the checklist... catheter in place, not kinked, tubing attached, all stop cocks open, transducer at heart level, tubing not kinked, pressure bag inflated, positive flow, a re-zeroing completed...

Still a wave form, correlated to the ECG, yet no numerical display.  A closer look at the wave form showed a systolic pressure below 50... A check of the femoral pulse, it was intermittent, barely felt even then.

Now into battle mode, as I only had a general knowledge of the problem...

Tank full?  Yes, over 6 liters of IV fluids so far.  Pressors?  Levophed and Vasopresin.  My decision and instructions: bump up the Levophed, call the Admit Team (they need to be at bedside!), and run in another liter of IV fluid until they get here.  What is the history?  ... a terminal cancer, end stage, probable metastases, failed G-tube placement, probable mesenteric infarction...

I changed my decision and instructions.  The short time they were in place and being followed, and before the Admit Team arrived, we regained a blood pressure of 50/32... a MAP of 38, which was obviously lower for the last five to six minutes as it wasn't even registering...  I then suggested we stop the IV fluids, lower the Levophed back, and wait for the Admit Team to arrive.  I looked at my peer, and saw that they knew, they just wanted someone else to make the decision.  So I said to them, "You did a good job, everything we could have done, was done."

One could see and feel the weight lift off of everyone in the room... which were only Nurses, ED Paramedics, and ED Techs.

Then the Admit Team arrived.

As they started to assess and shout out orders, no one moved, no one did anything.  My peers all just looked at me, some of them even left the room.

When the Senior Physician at bedside was finally able to understand that I was the defacto 'Resuscitation Captain,' they turned to me and asked for a synopsis, a report of the events that had occurred.  My peer, the Primary Nurse for this patient was near tears.  I looked directly at them and said, "Thank you for your help, go take a minute."  They left the room.

My synopsis was brief and to the point.  I also offered my suggestion that 6+ minutes of a MAP less than 38, is not conducive to a long term survival.  A MAP of 60 is necessary to adequately perfuse the end-organs... heart, brain, kidneys, etc.  This patient was now at a minimum brain dead, multi-system organ failure was impending.

They insisted on starting an Epinephrine drip and a few other things, that I ended up handling and assisted with.  All the time, I kept mentioning that, pardon the reference, "We are flogging a dead horse.  There is a time to just stop."

The patient made it to the ICU.  They died a few hours later.

There comes a time.

I feel like there is an explosive situation.

So, I plant my sword.

Not ignoring it, as it will always be ruminating...  just now, is not the time.

Perhaps, there will come a time when a fresh blade, means something else.


Peace!

Nothing to say, no stories, no adventures.

It has been a peaceful and uneventful few days off.

I am truly thankful.

Ahhh...

If you are looking for excitement and adventure... go Google something!  This post is boring.

Last night started out, with me oversleeping.  Was an hour late to work.  My bad, no excuse.  Regardless of the reasons, it occurred, was handled, and everything worked out.

My shift was busy, to say the least.  Yet in a strange way, it seemed relaxed.  Nothing critical, as in life threatening.  Had a few interesting presentations, definitely intervened and affected a few patients in a very meaningful way.

I thought about my patient the other night who ended up signing out AMA.

That was a difficult scenario.  They were brought to the ED for a reason, while there, was witnessed and documented to have a definite problem, that explained the initial presentation.  An enormous amount of resources were garnered together and prepared for battle!  Yet they recovered, were stable for the rest of their visit, and eventually wanted to leave.

As a Nurse, there are times that one has to become firm and somewhat aggressive with patients, who seem to not understand or have the ability to comprehend the situation.  So, when this patient told me they wanted to leave,  I responded to them that they were clinically dead, that I was just about to start CPR, that although I have 3 other patients, they are my number one focus and have my undivided attention at the moment, and that if they leave, there is a high probability that they will die.

The patient responded to me, "I do not want to take up your time, please, go take care of your other patients."

I was actually speechless for a moment.

Then they mentioned that they were hungry, and asked if they could have something to eat.  Now, in a presentation like this, it is an automatic NPO... nothing by mouth... Cardiac Cath, Pacemaker insertion, etc... all surgical interventions.

In the few seconds it took me to process the request... I said OK.  Went and got a sandwich, juice, and some chips usually reserved for our diabetic patients.  My thinking...

This patient already almost died once, maybe even twice.  I was not going to deny them a meal if they are hungry.

Another "WARBLE!"

Last night, I received a patient via EMS that had a syncopal episode... they 'fainted.'  Bystanders attempted to help, yet when the patient did not respond they called 911.

Upon arrival of EMS at the scene, the patient had a heart rate of 40-ish and a blood pressure in the 70/40 range.  Not very conducive to consciousness.  This patient's MAP (mean arterial pressure) was 50.  A MAP of about 60 is required to perfuse coronary arteries, brain, and kidneys...

Upon arrival to the ED, their initial blood pressure was about 90/60 (MAP of 70), HR was 65.  Conscious, alert, no complaints. 

Working as a Team, my peers and I quickly initiated interventions as we gathered information.  The patient appeared stable, yet guarded...  given the patient's immediate history (syncope), age, sex, and physical stature, these vital signs were not normal. 

I stepped out of the room to begin entering the Intake/Triage into the computer charting system.  I was 10 feet from the room, 15 feet from the patient.  The patient has been in the ED for 6 minutes.  I could see both the patient and the bedside monitor from where I was charting.

Then, the WARBLE.

I look up.  My first focus was to the monitor.  What is the alarm?  I see a heart rhythm scrolling across the left half of the screen... and a flat line on the right.  I look at the patient, there is something wrong.

I jumped up and started for the room, speaking loudly (commanding might be more accurate) I tell the Unit Coordinator to get help and call for the Attending Physician.  As I reached the patient's side, 4 seconds of flatline has elapsed.  There has been no heartbeat.  The patient's head is to their side, eyes open, a glassy stare into nothingness.  A quick check of the monitor leads to make sure they are all attached, and yelling/shaking the patient...  no response.  I flatten the stretcher, look back at the monitor, I see a two complexes... then flatline again...

At this time, I turned to the UC, to see her answering my phone and I hear her say, "He's already at the bedside."  I yell out to the UC, something to the effect of "get me some help."  Four more seconds have elapsed. 

I am literally about to find my landmarks, about to place my hands on the patient's chest, preparing to begin CPR... I look back up at the monitor, still flatline.  I look down at the patient, preparing... when they suddenly take a deep gasping breath and literally bolt up-right!

The WARBLE stopped.

Twelve seconds had elapsed.

My patient's heart rate had been... zero.  My heart rate was about... 100!

The patient had been clinically dead for twelve seconds.

Long story short...

After two hours of monitoring with no re-occurrence, and multiple Nurses and Physicians all explaining what had happened, the proposed plan of care, additional testing needed, and potential outcomes... the patient decided to leave AMA (against medical advice). 

In retrospect, this morning this patient probably was clinically dead at least twice.  Once at the scene, once for sure in the ED.  Yet, as an adult, of sound mind, now fully conscious and alert, has the right to make their own decisions.

I saved the telemetry strips.  Since the patient's information had not yet been entered into the telemetry system, there were no identifiers on them.


As they left, I said to them, "I think you are making the wrong decision, yet it is yours to make.  Take care my friend."

The patient stopped, smiled, and shook my hand.  Simply saying, "Thank you.  I really have to go."

I learned later that they went out into the lobby and asked the Frontline Nurse, "Can I stay here until the buses start running again in a few hours?"

Upon hearing this, I smiled.

Cleansing...

Had this evening off and was able to enjoy an Arizona thunderstorm roll in from the Northeast! I saw the clouds building, then the sky turn black, well before sunset... this was going to be good!

The radar showed an isolated cell steam-rolling off the Mountain, down through Sabino Canyon, and tracking straight towards me.  So when the storm got close, and I felt the humidity climb, and that faint change in wind direction that brings a few degrees of cooling...

I moved my bike to my recently offered 'premium' parking!  Went back, grabbed a chair, and sat outside to watch the show!

Looking North towards the Catalina's... they are almost half gone.

A few minutes later...

The wind and lightning started to pick up a bit.  The closest strike was 0.2 miles away (according to my lightning detector app...), didn't quite have a 'flash bang,' yet pretty darn close to it!

The main cell skirted just to the West of me, yet it still brought some nice rain for a couple of hours.  Of course the storm was well North of the airport... so it will probably be recorded as "trace" amount of rain.

It was very relaxing to just sit and watch the storm.  I marveled as my neighbors jumped from there cars and ran for cover... especially as I would occasionally stand up and walk out into it to get a better view of the sky around me.  There were a few that just shook their heads at me, as I saw them looking out from under their porches.  I just smiled.

An afternoon thunderstorm has such a cleansing effect.  The temperatures cool, the dust and smog are cleared, the air freshens, and a few good bouts of lightning and thunder, well it just seems to clear the soul.

I kneel...

Their comes a time, when one feels like they stand alone.

A gathering together, and one missing item...

Three days ago, I was a witness.  Regardless of the rituals, I represented myself, as me.  It is up to those around me, to understand who I am, and what I represented.

It was proper. 

She was protected.

Flash Bang!

And no it was not a grenade...

I arrived in PHX this afternoon, stopping at my sister's for dinner/b-day celebration for my nephew.

The circumstances are unfortunate, however I got to visit with a cousin for a short while that I haven't seen in many years.

I was a little wary about the weather, as I could see a lot of dark clouds off to the East.  I kept checking the radar.

As I left for the evening, I was entertained by an awesome show of lightning to the North of the Valley.  When I got home, a quick unload and off to get fuel, as I was just 5 miles from empty.  I made it back home and within a few minutes, the skies opened up!

Torrential rain.  So much so, that there was water running down the sidewalk, and my DTV was "searching for signal" for quite awhile!

Then...

The Flash, and before the light faded, the Bang!  Made me jump! And I was inside... I actually felt the percussion and my blinds began swaying... it was very close!

There was no thunder here... some of my friends and family might have heard some, all that we had here was a Flash Bang!  Nothing before, and nothing after.

Oh... BTW... the temperature dropped from 100 down to 75 in a matter of seconds!  I love the Monsoon!

Ripple effect...

Throw a pebble, stone, or rock into a lake and watch the ripples spread out... almost perfectly, uniformly, in a circle.  Until the wave of the ripple encounters an obstacle.  Then it bounces back, and the return ripple, although less intense, interacts with the outgoing ripples.  Sometimes cancelling, sometimes enhancing, even returning.

A perfect metaphor!

I have caused a lot of ripples in my life.  Some would argue, Tsunami like waves!

All I can do is smile.

I have affected lives... for that I am eternally grateful!

Lesson integrated!

I just finished a 4 shift marathon this morning and will now have almost a week off.

My plan was to pack, nap, and hit the road...  On the surface, this is a lesson that I apparently still have to learn.  However, in reality, I already have.

Last night was incredibly busy, and I had two critical patients at the same time for several hours.  At the end of my shift, I was both physically and mentally exhausted.  So when I got back to where I'm staying, I decided to stay an extra day, and get some much needed sleep. 

As I post this... 10 hours later...  I wonder what news stories my decision prevented.


Peace

Free Bike Wash!!!

I woke up this morning, to the sounds of an early morning storm.

The air was thick with humidity, even with the A/C on, and a look out the window confirmed it!  A total downpour!

When the rain stopped, there was a patch of blue sky to the East.  I grabbed a clean washcloth and proceeded to wipe down my bike.  There are only a few bug smears left on my windscreen, and the chrome is now blindingly reflective!

Unfortunately, I think the washcloth has now become a rag... I tried to wash it out in the sink, yet it is still dark/stained... I am sure the hotel will not return it to service.

As I was wiping down my bike, the proprietor of this establishment walked by.  He stopped and offered to allow me covered parking.  I could park my bike under a staircase in the middle of the buildings, or under the entrance canopy off to the side.  He was pushing for the entrance canopy, as he said, "Your bike will be in view of the front desk, watched all the time."  I appreciated this gesture, and thanked him.

As a Travel Nurse, living in a hotel for 13, now 26 weeks, one tends to establish relationships.  All of the housekeepers are my friends.  They know if the bike is there, it is an automatic DND, regardless of me placing that little placard outside on the door handle!  And I am probably one of the easiest guests they have, only requesting housekeeping once a week.  The Front Desk crew, are also on-board.  I occasionally need to print something from an email and or fax something... done "gratis." 

I now have covered parking available to me!  And a new friend as well!

Today I smiled.

Sunset

My morning started out very early, at least for my standards...

As I stopped to top off my fuel, I met a former co-worker doing the same.  A brief exchange, a renewal of friendship.

My ride back was nice.  Light traffic, overcast, and cool.  When one sees a biker flare up their elbows... they are attempting to scoop some air into their jacket, through the sleeves... an instant air exchange and cooling measure!  It is usually accompanied by a stretch and repositioning...

I arrived, offloaded, and settled back in.  A nap was had, and I awoke in time to capture one of the greatest things one can experience in Arizona!

 The Sun setting... behind a mountain range, lighting up the sky and cloud cover!


Peace.

Monsoon...

The "season."

Now it used to be defined as three consecutive days of dew points above 50%... marked by thunderstorms, dust storms, etc.

Now, it is a set date.

A few days, maybe a week ago, my dad declared the arrival of the monsoon based on the drip from his A/C.  Yet, the moisture was riding in on the jet-stream from the Pacific NW down into the SW.

The past few days however, the moisture blooms in Northern Mexico pushing up into the SW... this marks the beginning of the monsoon in my opinion!

Regardless, in the SW when temperatures routinely are above 100, 110, 120 during the heat of the day... those thunderstorms that develop, blow in, bring rain, and drop the temperature into the 70's or 80's in a matter of minutes... that welcome reprieve... this is what makes living in this region worth it!

I have been in regions that are cold, have snow, that are hot and humid, etc.  Personally, I prefer to be able to cool down vs. warm up...

The funny thing is... 4 or 5 months from now... this region has the potential for freezing temperatures!

So, I share these lyrics, from the song Turn! Turn! Turn! (to Everything There is a Season) by The Byrds...

To everything - turn, turn, turn
There is a season - turn, turn, turn
And a time for every purpose under heaven

A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep

To everything - turn, turn, turn
There is a season - turn, turn, turn
And a time for every purpose under heaven

A time to build up, a time to break down
A time to dance, a time to mourn
A time to cast away stones
A time to gather stones together

To everything - turn, turn, turn
There is a season - turn, turn, turn
And a time for every purpose under heaven

A time of war, a time of peace
A time of love, a time of hate
A time you may embrace
A time to refrain from embracing

To everything - turn, turn, turn
There is a season - turn, turn, turn
And a time for every purpose under heaven

A time to gain, a time to lose
A time to rend, a time to sew
A time to love, a time to hate
A time of peace, I swear it's not too late!


To my extended family...

We have experienced much in these past few months.  Please keep in mind, the season of our lives are turning...

May the Peace of the Lord be upon you and with you, comfort you, and guide you.  Amen.

So far... so good!

July is a hectic time for Nurses working in an Academic/Teaching Hospital.  You see, the next class of Medical Students begin their Residency. 

So, once again, we must increase our level of patience, provide that gentle guidance, and be evermore vigilant for the aberrant things that occur when a Novice enters the world of Experts!

It has been just over a week, and so far, so good!  A few minor blips, mostly to do with timing and prioritization... yet my fellow Nurses and I will not wait for a Physician to "catch-up" with a patient's condition.  We will usually implement and do what is necessary in an emergency situation, just telling the new initiates what needs to be done/ordered/etc.

I was most impressed last night, as a 1st year Resident actually asked me to review the orders she had just entered and offer suggestions as to what wasn't covered/what I felt was needed!  Now that Physician, will do very well in her career!  Less than a week into it and already a collaborative approach to providing care... one down, 1000 to go!

There is a definite difference between a 1st year and a 4th year.  It is also entertaining to watch the transition that occurs.  From being completely scared to death that they are now responsible for people's lives, to that overconfidence that builds, which leads to a correction when a Nurse refuses to do or insists on something, to eventually learning to trust and listen, to the point that they begin to actually rely on others.  And hopefully, eventually, they become 2nd years!

And the journey continues...

A funny thing happened to me yesterday...

In the Southwest, the Monsoon has officially began.  So, although I usually keep an eye on the weather when I ride, I have to shift it into high gear now; not just on a daily basis, sometimes even hourly!  A departure time difference of just 5 minutes, can make a huge difference!

So the second thing I do after waking up on a work night...  is check the weather!  Drat!  The fourth thing I do, is walk outside to look at the conditions.  Double Drat!

Thunderstorms are looming all around the area, although not yet raining where I am at, I can see a squall line to the North, moving SSW.  A review of the radar again, I estimate I have 20 minutes to get ready and on the road, in order to beat this and get to work.

I accomplish this task in less than 20 minutes and think to myself, "Bonus time!"

I have about a ten minute commute.  The ride was nice, as traffic was light, there was a light breeze coming from the NNE... outflow winds. I could see the rain off to the East, I was going to make it without a single drop of rain!

As I turned North, the wind calmed... I thought to myself, "Uh oh..."  So I started to replay in my mind the route I was on.  Where were the shelter points?  A place to pull off and seek cover... like covered parking, gas stations that have canopies, etc.

Then wind began to pick-up, now coming from the West, almost a complete reversal... uplift winds.  Then I saw the flash and heard the crack of thunder a few seconds later... I said to myself, "Oh shit!"  I now only had three shelter points, and one of them was arriving at work!

As I approached an intersection, about one mile away from work, the temperature suddenly dropped!  And I mean it went from 100+ to the 80's in seconds... I actually felt the chills!  Then suddenly, about 500 feet in front of me, everything turned white, except for the faint cherry red dots of brake lights coming on... there ahead of me, was my last shelter point before work.  I changed lanes.  My fear was the "white" I was seeing was hail.

Less than 50 feet from entering the driveway...

Whomp!

Not hail, but rain.  Torrential, all encompassing, instantly soaking.  It was like standing under a 30,000 gallon pool suspended in the air, and the bottom broke out!  I lost sight of the driveway for a moment even.

Needless to say, I did not make it to my shelter... I was instantly soaked.  And since I wasn't wearing rain gear... I mean soaked!  I pulled under the canopy of a gas station, pulled up to that center island store, and parked.  The noise was deafening!  I watched as the rain hit the ground, seemingly bounce and splash up!  The din of it hitting the roof... the roar of it hitting the asphalt...

Less than a minute elapsed, and it just stopped!  Now just a gentle sprinkle of rain, that probably would evaporate off of clothing in less than 20 feet of riding... the kind that you don't even have to turn a car's windshield wipers on for...

Then I thought to myself, "Holy $^(%!"  I just rode in a microburst!!

I walked to the NE corner... a brief break ahead, I even saw blue sky.  I grabbed my a towel out of my saddle bag, wiped down my bike (seat, tank, areas that would throw off even more water at me), fired up, and scooted!

I got to work with 30+ minutes to spare.  So I had a chance to recover.  I walked in, turned to go to a specific Unit I thought I could sneak into, grab some towels, and beeline it to a Staff bathroom to attempt to dry off a bit...  no such luck!  I walk into the Unit and there was a co-worker who started to smile, which turned into laughter, as they said, "You look like a wet cat that just jumped out of a bathtub!"

I smiled, grabbed some towels off the linen cart and headed on my way.  A few minutes later as I came out looking a tad more presentable, if one can ever accomplish this with "clingy" scrubs...  I saw a towel on the floor next to the linen cart.  Apparently, in the few seconds I stood there, I left a puddle!

Later that night, as I was relating my experience to another co-worker... all I could think about was the poor housekeeper called to mop the wet floors.  Arriving at the entrance I used, starting to mop, following a trail of water... it reminded me of the Pixar movie "Wall-E" and that little sweeper robot that followed Wall-E all around trying to sweep up the "contamination!"

End of discussion.

So, if I drop my helmet from a height of 3ft or greater, I need to replace it.  I am 5' 11" at minimum, sitting on my bike, I lose at most 2ft...

After several years, my helmet has been exposed to the elements, 3 to 5 years is the recommended lifespan of a helmet...

So, I will not argue what the DOT Standards are, I will let you read them and determine them for yourself!

http://www.fmcsa.dot.gov/rules-regulations/administration/fmcsr/fmcsrruletext.aspx?reg=571.218

Ask me again?

I have endured...

As I nurse, I see a lot of things.  I experience sights, sounds, smells...

I admit though, I have an "Achilles Heel."

No matter how bad the injury or illness, how much blood, the color of (insert bodily fluid here), what the odor is, or the grossest thing you can ever imagine...  I have probably seen it, experienced it, and dealt with it.

Yet, the one thing, that will bring me to my knees...

Is a sore throat.

I will curl up into a ball, sleep, drink my Sprite and Gatorade, eat my pretzels, take ibuprofen till my kidneys scream at me, and just wait for it to pass...

I can handle cough, congestion, headaches, fevers, NV&D, aches, just about everything that a human body experiences!  A sore throat though...

My worst enemy!  As it knows how to defeat me!

Alarms...

Any healthcare provider will tell you about all of the "alarms" there are on all sorts of electronic monitoring equipment in the hospital.  A long time ago, a Nurse could use there judgement and turn off an alarm.  Well, obviously there was an incident... somewhere...

Now days, all alarms must be on, and at full volume!  In fact, there are some hospitals that actually disable the ability to turn off alarms.  One can silence and/or suspend for a few seconds or a minute to correct the problem, yet once the timer runs down, alarm goes off again!  This is one of the major causes of the cacophony that is experienced when a person enters an ED.  It seems like a fairly chaotic place, people moving around, talking, the incessant dinging and bonging and beeping.  The unanticipated consequence of requiring alarms to be on and at full volume... it causes people to "tune" them out.  So when an alarm is "real" it may not be responded to so quickly.

However, the solution to this has been to create certain tones.  These tones are not heard often, so when they are heard, it tends to get the attention of the healthcare provider!

~06:51am:

The Nurse I was working with and I were talking about her father coming into town next week to help her drive back home.  She is a fellow travel nurse and her contract is ending soon.  She knew that I rode.  Her dad also rides and we were talking about her renting a Harley for them and her going with him for a day ride around the Tucson area before they left.

We were sitting at the Nursing Station, she at the north desk, me at the south.  There is a Central Station Monitor on the north desk at the east end.  A CSM is basically a computer screen that displays patient's heart rhythms from a remote telemetry pack that they are wearing.  This allows us to monitor all of the patient's heart rhythms from a single point simultaneously, rather than having to go into individual patient rooms.

The CSM was to my right, her left.  The angles made it so that as we were talking, we could each see the CSM.

06:52:56am: (Start time verified by time-stamp on the rhythm strips)

Out of the corner of my eye, I saw a particular patient's "window" turn from a black background to blue... then the "ding."  The patient had had a premature ventricular contraction (PVC).  As we both turned to look, the first PVC was immediately followed by a second... then a third...

My peer said out loud, and by out loud I mean loudly, "Oh Shit!  We both jumped up and started to move towards the patient's room... there must have been a fourth and fifth consecutive PVC... as the "ding" changed to continuous "bonging!"  Sustained arrhythmia...

I yelled for the PCT to grab the 12-lead EKG machine, I turned to grab the Crash/Code cart... the sixth consecutive PVC occurred... as now the "bonging" turned into the "warble," that no Nurse ever wants to hear... the phone started to ring...

06:53:06am (Time notified verified by event-mark on rhythm strips)

As I passed the desk with the Crash Cart, I saw it was from our Central Telemetry Department, I picked up and said before they could even utter a word, "We got it."  Later I saw that I had just dropped the handset and it was laying on the counter...

My peer reaches the patient's room, flips on the lights, starts Emergency Resuscitation Procedures.  Yells at and shakes the patient to determine responsiveness... no response.  She checks for a pulse... present but weak.  She calls out her findings... there is no need for immediate CPR.

I arrive with the Crash Cart.  PCT is coming down the corridor.  My peer once again yells at and shakes the patient... this time he opened his eyes... the "warble" stopped...

06:53:23am: (End time verified by time-stamp on the rhythm strips)

After a few seconds of a blank stare, the patient gruffly said, "What!?"  He was OK.


The patient had an episode/run of ventricular tachycardia (V-tach), a life threatening heart arrhythmia that if left untreated can quickly deteriorate into ventricular fibrillation (V-fib), which again left untreated, results in death.  This is what is believed to be the cause of "Sudden Cardiac Death."

27 seconds... from start to finish... and shift change was still 17 minutes away!  No need for a morning coffee.  It would take at least an hour for the adrenalin burst to wear off...

What truly amazes me, is that the two of us were able to recognize what was occurring before the computer did, and initiate a response.  It also amazes me that the three of us were already in a full response mode, well before the other human being in Central Telemetry recognized and initiated notification.

No one will ever know if this was a paroxysmal run of V-tach, or if my peer's yelling and shaking the patient converted him.  Usually, electrical intervention (a shock) is needed to convert this arrhythmia.  Yet, down the resuscitation algorithm, the first line drug given is epinephrine... adrenalin.  Perhaps the patient had just enough perfusion to allow his brain to react to the "startle" and initiate a natural "fight or flight" response... releasing a natural adrenalin bolus.

I began to chuckle.  My peer asked me what was so funny.  I began to relate the scenario I had just seen flash in my mind...

"Patient Codes!  V-tach!  We enter the room, determine unresponsiveness and pulseless, initiate CPR, expose chest, attach defib pads... PCT enters room and hits CODE BLUE button on wall... We shock!  Patient converts... awakens... is hemodynamically stable.  Four minutes later, when the CODE Team arrives because we forgot to cancel them... we are all sitting at the Nursing Station acting nonchalantly, like nothing happened..."

We all had a good laugh at that, especially after the patient earlier in the shift that had a seizure...

 07:05am

Five minutes to shift change... so far, uneventful, final approach, coming in for a landing...

07:10am

Our relief arrives.  My new friend and I can now relax... there are others responsible now.


Two significant events in a single 12 hour shift...  I can no longer say my week has been uneventful! 

Events...

I haven't posted in two weeks.  I really haven't done anything except work... no rides, the insights and observations I have had weren't worth posting, and about the only thing to note is that I renewed or extended my current contract.  Pretty uneventful, that is until last night...

In previous posts I explained the CDU (Clinical Decision Unit), well I was assigned there last night with two other nurses as there were ten patient's.  Two of us had three patient's each, the third had four.  Well, the two of us who had three patients, each ended up discharging to home one patient and fully admitting one patient.  So we each now only had one patient.  That was quickly resolved within a few hours, as several more patients were admitted to the CDU.

So far, pretty uneventful.  When my peer received her third admit around 11:30pm - a patient that reportedly had a seizure at home, brought to the ED, monitored for several hours, and finally the decision was made to keep the patient "overnight."  Now the patient had no further seizure activity while in the ED for the past 12+ hours.  The patient arrives, my peer goes down to start the process of admission to the unit.  The other nurse and I were sitting at the nursing station, reviewing charts, documenting, etc. when not 5 minutes later our peer walks calmly into the nursing station and says that her new patient was actively seizing.  We asked her if she needed any help and she replied, "umm... sure."

So as she is accessing medication to stop the seizure, the other nurse and I walk down to the room.  Yep!  They were seizing... full-blown, tonic-clonic, full body seizure!  Pretty scary thing to see for the first time, as was evidenced by the spouse standing at the foot of the bed wide-eyed, mouth open, staring...  As my peer turned the patient on their side, I hooked up and turned on the suction handing it to her so she could clear the patient's airway.  I then hooked up an oxygen mask and placed it on the patient.  Our third finally arrived with the medications, administered them, and within 45 seconds to a minute, the seizure stopped.  We monitored the patient until they started to regain consciousness, reassured the spouse that their loved one was OK, and finally left the room giving the spouse instructions to press the call light if the patient began seizing again or if they felt anything was wrong.  About 15 minutes total had elapsed since my peer came into the nursing station advising us of the situation.

The patient's nurse immediately put a page out to the admitting physician.  While waiting for a callback, she called the ED Clinical Leader (Supervisor) to inform them that the patient had had a seizure and is not appropriate for an Observation Unit and needs to be admitted to an inpatient bed.  About 3 minutes later, in comes the ED Supervisor, closely followed by the ED Attending, then between 3 and 5 ED Residents (hard to tell as they tend to move in packs trying to jostle to be the first one in the room behind the Attending to get a prime position), followed by the ED Pharmacist and a Respiratory Therapist!  And they all looked at the three of us, four actually as the Patient Care Tech (PCT) we had on the Unit was there, sitting rather nonchalantly at the nursing station.

Once they passed, the four of us just looked at each other and someone asked, "Why the 'Rapid Response Team'?"  Well, a few minutes later out come the 5 residents (yes, the tend to walk in pairs or singly when not in a rush), the pharmacist, and RT.  The supervisor and the Attending stop at the nursing station to ask what happened.  When my peer explained what was observed, what our treatment had been, and the patient's response, the Attending nodded and said, "Good job," then left.  The ED supervisor stayed and admitted that they were a little perplexed to see the four of us sitting at the nursing station like nothing happened when they came in.  I responded, "The patient had a seizure, all four of us are highly skilled and experienced ED staff - it happened, we responded, we did, we fixed, we left!"  She smiled, and chuckled.  I continued, "Sometimes doctors get in the way of getting things done, it's best to call them and tell them what happened after one fixes the problem."  This time she laughed.

The patient was quickly admitted and transferred to an inpatient bed.  And the rest of the shift was uneventful...

When another patient... at 06:52am... a mere 18 minutes before shift change...


Well, that's another story, and since this post is getting long, you'll just have to come back tomorrow to read about it!

Ten Commandments

I mentioned The Two Rules.  They are absolute.

There are also Ten Commandments.  To fully understand, one must read the book, "The House of God."

Published in 1978, it was a satirical look into the practice of medicine.  There have been a few changes since then, yet even today, it is still a poignant review.

When I was a Paramedic, a fellow Paramedic and I created the 'Ten Commandments,' based loosely on this book.  He received his release a year later, I have been the "keeper" since, so to speak, so now I share...



I. If there is a chair, sit the fuck down!
II. Always check your own pulse first.
III. If they are alive, give them half an amp; if they are dead, give them a full one.
IV. Never figure your own drug dosages.
V. There are only three drip rates: TKO, W/O, and titrate to effect.
VI. If the baby drops, pick it up.
VII. All bleeding stops, eventually.
IIX. Air goes in and out, blood goes round and round, oxygen is always good.
IX. The man with the gun, always calls the shots.
X.  When all else fails, patch!

There is some sound advice hidden in this.  Like anything, there is meaning and thought behind every word.

Rest in Peace Bear!  I shared it, as it should be!

An Old Man

I admit, I am an "old man," as a mid 20's coworker jokingly referred to me as...  I am actually old enough to be their father... now that's humbling.  I can only imagine what my older peers think, when they are working with me!

It is a continuum.  Elders passing along knowledge, challenging, allowing exploration, and just watching.  Sometimes someone comes up with an idea... that is when I revert to the Two Rules:

First, don't kill anyone.
Second, if you don't know ask!

Surprisingly, this is not limiting at all.  The effect is that it makes one critically evaluate things.  And this is good.  I have had doctors ask me questions about proposed treatment pathways!  Ultimately, it leads to a truly collaborative approach to the task at hand.  Especially when I am old enough to be their father...

It is not my actual age however, it is my experience.  And I fully admit it works both ways.  An "old dog" can be taught new tricks!  That's what keep me young.  I learn something new everyday!

I am a front line individual.  Academics teaches the basics... bedside and doing, teaches reality!  The hardest transition a nurse has, is the movement from theory to practice.  I share freely; I give my interpretation, and suggestions.  Yes, sometimes I am wrong, yet the Two Rules always protect the charge...


Isn't that what it is all about?