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.