The High Road?

What exactly is taking the high road?

I guess that's a vague question, and I guess the answer depends on the situation.

If someone asked me this question in general, I'm inclined to think that the high road is usually choosing to ignore something offensive rather than doing or saying anything in response. The idea is that you don't "stoop to his/her level," assuming there is a "his/her" in this general situation. You take the high road by diffusing the situation instead of fueling it.

In general, that sounds pretty good.

In general, I struggle with this. Maybe not in the immediate situation, but definitely after the fact. If someone says or does something to offend me - someone I don't know well - it may appear that I take the high road because I don't always know how to react. But inside I'm fuming, and a few minutes too late I think of a few perfect things to say in response to whatever was said or done. So perfect that I really want to walk back up to the person and lay it on 'em. It'll be clever and smart with a little zing, and the person will feel bad about whatever he or she said in the first place.

What? No.

If you can respond with that clever, smart little zing without skipping a beat, maybe you'll have some impact. Or maybe (probably) you'll just spark an argument. But coming back with a delayed response to the offender? Someone you don't even have a real relationship with in the first place? There's nothing to gain, and the "perfect" words you've been stewing over probably feel foolish as soon as they leave your mouth.

So, as far as this person knows, I said nothing, and I'm not writing a situationally-inspired blog post about them.

...but for the record I think this person sucks, and I think the words I didn't respond with are awesome.

XOXO,

Kristin

This week I took the ONS course to become chemo certified (rather, chemo "competent"), which was somewhat terrifying.

Terrifying that we are responsible for managing some complicated therapies in the midst of the usual floor chaos? Yes.

Terrifying that that we wear a special gown and gloves to be sure we don't come in contact with even a drop of the medication, yet we are infusing it into someone's veins? Yes.

Terrifying that certain chemo drugs almost guarantee hypersensitive - possibly anaphylactic - reactions at some point during the infusion? Yes.

...and that the management of that hypersensitivity involves more benadryl, epi if it's really bad, then continuing the infusion? Yes.

It's probably the most terrifying that, without warning, at any moment, any one of us could be facing this sort of situation. And really, that is an incredibly cliche statement to make. We have all said or thought at some point in our lives, maybe after a "close call" of sorts or prior to the yearly turkey/mashed potato/pumpkin pie nirvana, but truly. Truly. Have you thought about it lately?

This morning I ran 10 miles. I'm about a month and a half deep into half-marathon training with Rogue, and we run our long runs together on the weekends. I cursed this fact when my alarm went off at 6:15. At 6:30 I prayed to Grilled Cheezus that my usual pre-run toast/peanut butter/banana combination would still be good to me this week. At 7:15 we looked over our course maps and discussed how the ugliness of our toenails is is directly related to our mileage per week. At 7:30 we were off, and the continuous beeping from everyone starting his/her watch was, per usual, ridiculous. In the first 3 miles I found out that someone has a job interview next week, someone else is going to a wedding tonight, and another has a 4-year-old daughter that cut her own hair yesterday, cried, and asked if she had become a boy. Someone else already had to pee, and I sympathized with her impatient tiny bladder. We split up after mile 4 when the 8-milers hit their turn-around point, and I still had another mile out. Other runners from the marathon group passed me on their way back from their turn-around point, and I wondered how far they were going today. After 5 miles: water, gummy bears, and turn around to do it all in reverse. The rain actually felt sort of refreshing, though it did nothing for my attempts to distract myself from the fact that I had to pee. I was too far behind the runners in front of me to talk to them, but close enough to have someone to follow. I wondered if they, too, had to pee. I pulled out a few more gummy bears around mile 7 or 8, and I felt ultra guilty because I ate them near a homeless dude. I got back just before 9:30, joined the masses for foot drills/streching/recovery chocolate milk, wondered just how sanitary the community ice-bath so many were soaking their legs in really is, and went on my merry way.

Work life and normal life are two very different things.

"But isn't it depressing seeing people like that every day? I don't think I could do it."

Well, it's work. It's a matter of context. Lines, drains, tubes, neutropenia, nausea, numbness, pain, fluids, narcotics, incontinence, transfusions, complications, blah blah blah - everyone's got something.

...But isn't it weird that a normal day at work consists of everything that would not be normal in someone's life? It's nice to remind myself of that every now and then. And it's humbling.

The ability to get out of bed in the morning.

The ability to walk across the room without thinking about it.

The ability to eat and have an appetite.

The ability to talk to people.

The ability to pee.

(...and the ability to control when that happens).

So truly. Have you thought about it? Today I was intensely aware of my health and the thousands of components that contribute to it.

Love yourself. Love your body. Give thanks.

Cowboy Cookies

Happy October! I've been craving cookies all week long. Any cookie. At work on Tuesday I ventured down to the hospital gift shop and came back with a package of Grandma's brand chocolate chip cookies. The picture on the front was enticing.

...The cookies were disgusting. As in, I ate half of the first one and threw away the rest.

That's what I get for becoming a cookie snob.

After careful consideration I decided cowboy cookies and snickerdoodles were in the cards for my days off. For some reason both of those sounded appropriate for the new fall weather - or maybe just my craving.

(Un)fortunately logic got the best of me, and I only made one of the above. Can you guess which one? Of course you can. It's the title of this blog post.

Make these. I used the famous Laura Bush recipe floating around the internet, only I divided the recipe into thirds - the original is huge! Everything about this recipe is easy, and the end-result is really delish. You could probably play around and substitute other things for the chocolate chips/pecans/flaked coconut, though I don't know why you'd want to.

ICU/IMC/9East?!

I've only been an RN for a year plus-a-few-months, but in my short experience on an acute care floor full of potentially non-acute patients, I have never seen a physician make a decision to transfer a patient to a higher level of care without nursing pestering them (for hours) about it first.

Why is that? Why does it take multiple phone calls, the critical response nurse, the charge nurse, and the floor manager to convince the doctor that someone with consistently critical potassium values for 48 hours might despite constant IV replacement might (read: definitely) need to be on telemetry? Why is the resident not concerned over the fact that my tachycardic hypotensive patient has had ZERO urine output in the foley since the night before? Is it not obvious that the patient floating in a lake of her own blood every hour with the most whacked out labs of all time requiring constant transfusions might need to be on a floor where the nurse doesn't have four other patients to take care of?

I can think of a few patients in particular who we got transferred to the IMC after hours of paging, re-paging, arguing, and putting all my other patients' care on hold, and in every single one of those situations, those patients ended up spending weeks in the ICU.

One of them is still in the ICU.

When I started I didn't have the confidence or the experience to tell these reluctant docs that I disagreed with them. I would have thought that they know better, and if they think this patient should stay on our floor, then the patient should stay. Now thinking about the handful of way-too-sick-to-be-on-our-floor patients I've dealt with, and how taxing it has been to get them transferred no matter how obviously necessary it was, I am wondering what would have happened had nursing taken the lazy/passive route during those shifts.

I don't say this to throw our doctors under the bus. We have great doctors where I work. Wonderful, smart, great doctors. I'm not saying they should just know when the nursing care involved becomes too much for a nurse taking care of 5 patients. How would they know that unless we speak up?

...But really? Why am I the only one concerned about these un-replaceable critical chemistries?

Are patients only considered critical once they are arresting from their critically low potassium levels? Because it's going to be harder to call you and have a conversation about this when I'm doing chest compressions.

Beginnings

This time last year I was mourning the loss of the ever familiar first-day-of-school. And it wasn't just the first day of school, it was the long, painful walk home from the Co-op with 900 pounds of books, the new box of pens to replace the 50 new (read: lost) pens I bought last semester, the confirmation that, indeed, no one else did the "pre-reading" either, the first-day-of-school drinks downtown, and the first-day-of-school hangover. This time last year, I was missing what had been.

And I struggled with life and my new place in it.

Even now I still mentally break down my calendar year into semesters, which doesn't make any sense considering my schedule couldn't be more unfitting. I'm more likely to be working during typical "break" times, and I'm most likely off when the rest of the world is working. Christmas break might only consist of two days off near-ish the holiday, but on any random week I might be off for five days for no good reason. There are no more definite "starts" and "stops" during my year, which I originally thought would make for quick burn-out and time that stands nearly still. In reality, though, the past year couldn't have passed more quickly.

Some things changed.

And others never will.

There have been new adventures.

And time to do things simply because I want to do them.

I'm not sure at what point I will stop considering September to be the start of a new year. Until then, cheers to the past, present, future, and the lovin' from the oven I plan to bake all day tomorrow.

I've been very judge-y today. I get very judge-y when I drive and when I go to the grocery store. Particularly HEB. Is there anything more annoying than HEB? Particularly, the people (zoo animals?) in HEB? Anytime after 12:00 noon is a bad time to find yourself in that store, but precious kitty needed her precious kitty food this afternoon. A few things:

1. Now, exercise is hard, but I have confidence that you can huff and puff your way across the parking lot aisle to get your cart out of my now-ruined parking spot.

2. Stop listening to your i-pod. It makes it difficult for you to hear me growling while you daydream your way down the aisle in a zig-zag pattern.

3. Why don't you go ahead and touch all the apples before you put two in your little baggie? Maybe you should lick them, too. I want to bring as much of this moment home with me as possible.

4. I'm sure you mean well, cute-old-lady-on-a-motor-scooter, but those were my ankles you reversed right into. Check that blind spot.

5. Control your children. Tranquilize them as needed.

6. A pre-requisite for using the time-saving self-checkout is knowing how to use it. The trick is following both the spoken and written instructions, but maybe that i-pod blaring into your ears is putting you at a disadvantage.

And, finally,

7. If you want to take my parking spot as I get the hell out of there, it's courtesy to leave enough room for me to avoid pulling an Austin Powers as I get the hell out of there.

In other news, I saw a former patient during this HEB adventure also. We made awkward eye contact, and it's been driving me crazy since then trying to remember what he was admitted for. I still don't have the slightest idea, but I do know that I didn't like him.

I'm full of sunshine-y information today. Honesty is a virtue.

Actually I guess that's supposed to be "patience" is a virtue, but based on everything I've just said I obviously have none of that.

Happy Saturday! Or Tuesday for those of you with normal jobs and lives :)

I don't have many words. My mouth is too full of these cookies for words.

(...and my hands are too full from holding them to type...? Or something).

Actually that's just an excuse to save time because uploading the pictures took a l o n g time. I am not eating these right now because I nearly made myself ill off of them yesterday.

...But there's always tomorrow.

Mix the dry stuff.

Add some softened butter and an egg. Mix on low til it turns into dough (rhyme).

Make balls. Smoosh them.

Take them out right after they've cracked on top. Cool em off.

This filling, ladies and gentleman, is SPOT ON for oreo filling. I was grossed out by the need for shortening, but luckily I'd already spent too much money on organic-y non-trans-fat-y shortening the last time I crossed this bridge. And, in this case as well as the last one, it's completely necessary for texture.

My professional pastry bag.

Organization my dad would be proud of. I'd already smooshed the first 3 pairs together before I remembered to take this.

For the win.

The recipe is from Smitten Kitchen, and the recipe is here. I made mine smaller than hers so they'd be more true to regular-Oreo size, and I ended up with about a million of them. Half a million got sent to Julie to aid in her survival of med school, half a million went down my throat yesterday, and the other half million (?) will keep me happy for the next few days. Milk is a must. You need these in your life, trrrrust me.

"Can you believe this cake is gluten-free, sugar-free, egg-free, and it contains no dairy products?!"

...Well, I guess, but I'm not sure I want to eat it after that stellar description.

I'm not ragging on people with allergies and intolerances. I think it's great that someone's figured out how to make food that resembles the real deal without using, well, any of the things that define the food in the first place. Kids with celiacs can have a birthday cake? Rock on. I love it.

But as for everyone else - really? You pureed black beans into the brownies? You spent 900 dollars on obscure flours? And 900 more on a whole bag of xantham gum you're going to use once to hold the obscure flour concoction together?

If you need some extra fiber in your life, eat a salad. No one wants black beans in their brownies.

Good talk. See ya out there.

An addendum to yesterday's bitterness:

0500, my phone rings, I jerk awake thinking they're calling to tell me I screwed up my clock re-set and am now late for work.

"Kristin? We're canceling two nurses, you're first up."

"Yes."

"Go back to sleep."

At least, those are the highlights I remember from the conversation.

Zilker Park Kite Festival? Town Lake? Yes, those things sound appropriately opposite-of-work.

"Are we being too literal?"

"No you fool. We're following orders. We were told to comb the desert so we're combing it."

Anyone? Anyone?

There was a period of about two years (circa 1996-ish?) where I would watch that movie with my best friend every single time I went to her house. That is, after a few rounds of The Addams Family board game. It never got old. It still hasn't.

The movie, that is. It was on TV today. I can't vouch for the board game. Although if I learned anything from nannying last year it's that no board games are fun. Wah wah wah.

Tonight at 2 AM our clocks move forward just to piss me off, I'm convinced. As if 5:30 doesn't come soon enough already. I set my clocks ahead on my microwave and stove this morning to try to trick myself into going to sleep early tonight. We'll see. It's a pretty sweet deal for night shift. I, too, would like to "spring forward" in the middle of my shift.

Other happenings:

1. Kori and Adam's wedding is going to be perfect. I can say that because I know what the cakes are going to taste like.

2. John Mayer continues to be perfect. I can say that because he sang me a few songs at the American Airlines Center last week. No big deal.

3.

So, rather than going into great detail and creating a nice little HIPAA violation, I'm going to be general about this.

Sometimes, I hate people.

I'm really nice to patients and their families. Too nice. I'm very patient with patients and their families. I know what it means to be empathetic, I recognize my job is to work closely with people who are likely to be under stress, and I bend over backwards to be right there with them. It's my job. It's something I like about my job. There's something really satisfying about ending a shift having ridden out a roller-coaster of a day with a patient - celebrating the highs, pushing through the lows, and working to improve at least one part of that person's day. Recognition doesn't necessarily need to be verbalized in order to be understood - though sometimes it is mentioned, and that's another special part of this line of work.

But that's not what this is about. This is about hating people.

On this end of the spectrum, "liaison" becomes "messenger." As in, "kill the messenger." No no, I guess as in "don't kill the messenger," but we can't always have what we want now can we? Now I'm not as tough as that nurse who's been around the block for 20 years, but I'm not complete mush either. I get your frustrations. I get it when I'm telling you something that you're not going to like. I'm right there with you. You might not like it, but I work to make sure you know why we're doing it or why it's happening. I'm on your side, people. I'm sorry the doctor did not discuss this unpleasant piece of information with you and left me in the trenches taking your bullets.

But I can't deal with unwarranted disrespect. There is a difference between frustration and disrespect - primarily that I'm game for the former and hating you for the latter. In this particular non-specific, non-HIPAA-violating case, I rode out approximately 3 hours of this behavior hanging on to the last shred of empathy in my body, but they lost me in that last hour. And when I left my shift 25 minutes late fully and 100% because of these people, I saw the CA taking them towards my elevator to be discharged, and you better believe I hit the "close" button without a second thought.

Don't expect me to take the high road past 7:30p when I'm pissed off and starving.

Back in early December, I birthed a kitten. And by "birthed," I mean adopted from Town Lake Animal Shelter. Ever since then I've lost my mind. I made Lora come by my apartment the first day I had to leave her at home for work to make sure she was alive. I almost cried the night one of my patients (expectedly) died at 7:05pm because the extra paperwork meant I would be an hour late getting home. I almost cried when I dropped her off to board at the vet's office while I was in Tahoe. I called the vet while I was in Tahoe. I did cry when I came home from work the other week to discover she was stuck under my dresser, and, according to her full dish of food, she had been there all day. I lovingly towel her little kitty feet after I lovingly yank her from out of my just-used shower, and I lovingly ask her why she isn't one of those cats that hates water.

Juno thinks she's people, and clearly so do I.

Hi there darling. I like your face. Even when it is relentlessly smushed against my own face at 4 in the morning.

Ever slept with a kitten scarf? It's toasty.

I'm okay with being the cat lady.