Stick a Fork in Me

I'm DONE!

I am still waiting for it all to hit me. I thought about it all day at work today. I joked about being sentimental to give pre-dinner insulin for the last time at Brack. I wondered if hanging cytarabine would be my last chemo infusion should I not end up working oncology in Virginia. I thought about how it was likely the last time I'll see the people I don't even know on a personal basis: the pharmacists, the docs, the residents, the night nurses I don't know very well. I thought about how I won't be going back next week to find out how one patient did with part 2 of her surgery, or if another patient finally ended up getting to go home.

But I didn't feel any different because none of that really seemed like the last time. When I clocked out I was thinking about what I wanted to eat for dinner and how many dishes are piled up in my sink.

What I do know is I am so excited for brunch tomorrow - I just did a head-count of the people who plan to be there, and there should be around 15 of us, give or take a few. 15 (over-worked/underpaid?!) RNs with Sunday mimosas. I hope Taverna is ready for us. I didn't feel like I got to spend much time with whoever was working with me these past 2 shifts because all of us were busy, and I think my heart needs tomorrow's brunch to actually spend some quality time with this group of people that has been such a positive presence in my life the past two years.

Are you reading this Brack friends? Cuz I love you guys. When I think about all of my hardest days as a nurse, the first thing that comes to mind is how much you all helped me when I needed it the most. I'm proud of the nurse I've become and owe so much of that to you. I feel blessed - maybe even spoiled - to have worked with co-workers as fantastic as you all in the first years of my career. The words "I hate this place" may have escaped my lips on more than one occasion, but I wouldn't trade even the craziest of patients if it meant I had to have co-workers who were any less than the best.

So now what?

Immediate priorities:
1. Introduce moisture back into my hands during this period free of hospital sanitzer. This will be a difficult challenge, but one I am willing to conquer.
2. Baked donuts. I have all these recipes and a donut pan (who owns a donut pan?), and now is the time for experimentation.
3. Houston rodeo and BBQ with my dad next weekend.
4. Read books.

(And, ya know, find an apartment/job/life in Virginia. Baked aforementioned donuts for Andrew when the recipe is perfected. All of these things don't need to be listed, they are just assumed.)

Isn't it amazing when you know you've been through something and spent time with people you'll never forget? Life is so good!

Forming a Habit

There is something really unsatisfying about the type of title I just typed for this post. The type that is, essentially, exactly what the post is about. No pun. No joke. No creativity.

Why are you reading this again?

Anyway. In light of my upcoming move across the world (or a few states) I am re-committing to this blog and plan to make a habit of it. It's the best way I can think of to take you all with me.

...Which brings me to my next point: "You all" at this time consists of... three people? Four people? I used to link to my blog on Facebook until I felt awkward thinking about how many random people might be reading, but if someone has access to my Facebook, why not the blog? It's harmless enough.

Unless you are one of the morons at HEB. Then this blog might offend you.

Moving day is in April my friends! I will know the exact date once I lock down an apartment during my trip out there in March. In the meantime, the Bucket List is growing, but this is what I've got so far. I'll star the ones I've been to since the official list got started, but most of those are going to at LEAST need one or two more stars each. It's no surprise that most of the bucket list is food-related.

Home Slice*

Kerbey Lane*

Guero's

Torchy's

Amy's Ice Cream*

219 West happy hour

Rather Sweet Bakery and Cafe (Fredericksburg)*

a night out on dirty, dirty 6th Street with disgusting, disgusting shots

Alamo Drafthouse - either a sing-along/girlie night/quote-along/master pancake theater

County Line

kayak on Town Lake

UT campus/tower*

Oasis

smoothies from Lift Cafe

Milk + Honey Spa

Taverna brunch

Z'Tejas brunch

Esther's Follies

Mexican martinis from Iron Cactus

Who's in?!?! Please add to my list because I know I'm missing important things :)

Drumroll Please...

...........

...........

...Okay I don't think that did anything to create dramatic effect. So without further ado, THE big announcement. The one most people already know. The one that will change life as I know it in just a few short months!

(No, not pregnancy. Definitely not pregnancy)

Tomorrow I plan to make it official at work, so now it can be official in public (and by "public," I mean the handful that know this blog exists): I am MOVING to Fairfax, Virginia in April! Why, you ask?

To say we need a little more face time would be an understatement. The bottom line? We would really like to be able to have dinner and watch TV together on a week-night. The thought of being able to do something so normal is what I am most excited about.

So big changes are a-comin'. I am a big ball of nerves thinking about being so far from my family/friends, good Mexican food, Homeslice Pizza, and flip-flops in January, but I am looking forward to new beginnings, an excuse to buy one of those long winter coats, our nation's capitol, and that goofball I kinda like hanging out with.

Don't be fooled by the composure of this post.

I'm most definitely freaking out.

EEEEEE! :-P

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.