Friday, August 31, 2018

Lessons Learned from the Other Side of the ICU Bed

Six years ago, we lost an amazing patriarch. As the nurses in the family, and the oldest child/grandchild, my Mom and I flew to Michigan to be there with our grandfather and his wife as difficult decisions were made. Dr. Frank McDonald was a rocket scientist (literally). He was chief scientist on the Voyager spacecraft, which would exceed all expectations as it spent decades looking for the edge of our solar system. He has a wikipedia page which outlines his scientific accomplishments. Grandpa McDonald was the Sun in our McDonald family solar system. He always said he wanted to die at his desk, and he would retire from one job only to go on to the next one. On August 30, 2012, he was giving a scientific lecture to a group of colleagues. He finished his talk and collapsed. On EMS arrival he had agonal respirations and required intubation. Treatment at St. Joseph's Medical Center quickly revealed a massive cerebral hemorrhage (he was on warfarin for atrial fibrillation).

Stepping away from the emotion of losing a beloved family member, there are three very specific things that stuck with me during our experience. Things that I had to appreciate from the family member perspective in order to truly integrate them into my own practice as an Acute Care Nurse Practitioner. I have shared this story often, but as the anniversary passes once again I thought it time to write it down.

1- When delivering unexpected news, provide information in small bits and ensure family members have the information they need to take appropriate next steps. My Mom and I are a high functioning nurse and NP. We eat crisis for breakfast. Our every day at work is often someone else's worst day. On August 30, however, I vividly remember myself walking around in circles, packing a bag without actually accomplishing anything, while talking to the trauma social worker from the St. Joe's Emergency Department. She gave me step by step instructions: "Get a pen and paper. Here is the address of the hospital. Here is the airport you need to fly in to. Here is what to do when you get here." Without her to focus me, I'm not sure how the details would have gotten taken care of.

2- Color-coded scrubs truly are helpful for patients, families, and visitors.
Our hospital was just starting a conversion to color-coded scrubs when I traveled to Michigan (RNs were to wear navy, Nurse Techs a carribean blue, PTs and RTs maroon, etc). There were mixed feelings about this among staff, as it was a big change and seemed to take away some independence and creativity. On the other side of the bed, as a family member, the colored scrubs were incredibly helpful. St. Joe's had fully integrated this into their dress code, and I knew anyone walking in with grey scrubs was a respiratory therapist, anyone in blue an RN, etc. It helped know to whom to direct which questions, and provided a sense of structure. There was also a key to the scrub colors hanging on the wall in the room to clue visitors and patients into the color scheme.

3- A "Comfort Tray" is one of the most thoughtful and underutilized support mechanisms we have for family members in critical care.
After spending a night of very intermittent sleep in the ICU, I awoke to a cart in the corner that held bagels, pastries, coffee, and juice. There have been countless times I have given family members a gentle reminder to take care of themselves and make sure they sleep and eat. To have someone remove the thinking for me and give me the tools I needed to take care of myself without having to leave my grandfather's room was a huge gift. It was a reminder that the staff wasn't just taking care of my grandfather, but us, as well. With the tray was a thoughtful note from the hospital and their palliative care team letting us know they were thinking of us and offering something small to help ease our journey. I had never ordered a comfort tray prior to that experience, but now I do it often. That small gesture meant so much, and allowed us to focus on other things.

While none of us hopes to walk in the shoes of our patients or their families, it is often inevitable. Taking time to reflect on that perspective can help us to further hone our craft and provide even more exemplary, evidence-based, and compassionate care.

Monday, May 23, 2016

Charging Over the Hill

For some reason, 40 is an age that has always held a negative connotation. 40 puts you "over the hill". Technically, the average life expectancy of a woman in Maryland is 81.27 years, so perhaps 40 is mid-life.. but why is it an age to be dreaded???? I never really gave it much thought. Now, with 24 days to go, I am pumped!

Yes, things are sagging that I wish weren't, yes I will need reading glasses before too long. All things considered, I don't dread 40. I AM EXCITED to turn 40. 2016 has been a banner year so far and it isn't even halfway done. At 40, I've learned lessons I wish I had at 30. The past few years have not been the easiest, but I'm hitting my stride in my professional life, my family is amazing, and I have the best friends anyone could ask for.

I still have lessons to learn. I let the moods and attitudes of others impact me more than I should. I'm not good at saying "no" when I'm asked to take on something new, even if my plate is too full. I have learned, however, to appreciate the small things, the downtime, the quiet in between the chaos.

So as I turn 40, I embrace the last 40 years and look forward to the next 40. I am beyond thankful for those who mentor me, who put up with me when I hit a stumbling block (or have a complete and total meltdown), and those who encourage me. Here's to charging up the hill and embracing what comes next!

Sunday, February 21, 2016

"Yes You Can"

Several years ago, I regularly attended my friend Sherri's spin class. Sherri has a way of being incredibly motivating as an instructor, and often uses the phrase "Yes You CAN". She also says "you can do anything for 30 seconds (or one minute, or one hour)"... a phrase I repeated to myself often during triathlons and running races. More recently, at a different gym, my trainer Emily often says "Yes You CAN" while motivating her classes. She also says "If it does not challenge you, it will not change you." On rough days at work I repeat this phrase to myself.

Yes...these are motivational phrases used to help participants get through a one hour fitness class...perhaps not something people would see as life-changing. For me, every time I hear these words spoken, I want to work a bit harder, to push further, to realize that next goal.

It isn't just at the gym... This year I have had the opportunity to realize a goal I have attempted to achieve three times... a spot on the ballot for a position with a nursing organization I have worked closely with for over a decade. The first two times I didn't make it, but I am fortunate to have several amazing mentors who are leaders in critical care nursing... It was them telling me "yes you can" that led me to apply another time... them telling me "yes you can" that led me to believe I was worthy of applying in the first place. There are many amazing critical care nurses and nurse practitioners out there, some of whom I get to work with daily. So what makes me think I am qualified for this position in the first place? The people who told me "Yes You CAN".

So often we are focused on looking forward, on the next task or next goal. I am absolutely guilty of this at times, but also find that taking a moment to encourage someone else when I am struggling can help me to refocus. If we take just a minute, to look over our shoulders and extend a hand to someone who could use it, and say "Yes You CAN"... how would that impact the world around us? It doesn't have to be someone who is facing an immense challenge... perhaps someone who is already excelling at what they do.. or someone who could use that little push.. Take a moment to say "Yes You CAN", and see what happens.

This topic has been on my mind a lot lately...especially in Emily's class when she says those three little words. Today, a friend shared a story that has gone viral. It is a potent reminder of the amazing things that can happen when just one person says "Yes you CAN." Take a minute to read the story of Sam, the dancing Barista, and then ponder how you can do the same for someone else, even if on a much smaller scale. 

Monday, February 1, 2016

Groundhog Day: One Mom's Story of Stroke Survival

Disclaimer: This isn't my story. This is Amy's story. I was fortunate to be her caregiver, and now her friend. I have Amy's permission to share her story because stroke awareness is so very important.

If you have seen the movie "Groundhog Day", you know that Bill Murray gets endless attempts to live the same day over and over again, until he gets it right. Many of us in healthcare wish we got "do-overs" when we think we could have diagnosed a problem sooner, or treated it differently. But we don't. On Groundhog Day 2006, things went exactly right on the first try...

Amy's story could have gone so differently. It could have been the story of a young mother who suffered a debilitating stroke, unable to use one side of her body and unable to speak. Perhaps with extensive physical and speech therapy, her condition would have improved. It would have been a long time, if ever, before Amy returned to work. Amy's husband Chuck would have been supporting her recovery and parenting their two young sons.

Instead, thanks to an astute coworker, educated EMS providers, and a push to give tissue plasminogen activator ("tPA" or the "Clot buster") to stroke patients, Amy's story is very different. Amy was working at a local school when she developed the weakness and inability to speak clearly. Her colleague recognized the signs and called 9-1-1. EMS providers rushed her to the Emergency Department with extensive detail about her "time last known normal" and her symptoms. In the Emergency Department, staff acted quickly to perform the necessary tests and begin tPA administration. This is when I met Amy, as I helped to support the staff in giving the tPA. This was our second time ever administering it, and frankly, tPA scared us. The concerning side effect is bleeding, especially in the brain, but without it the recovery prospects may be dismal.

Within hours, Amy was moving both arms and legs...soon she was able to begin speaking. I will never forget her telling me how bothersome the bright lights had been, and how loudly everyone spoke to her because she couldn't talk back. Amy left the hospital with minimal disability. She underwent follow up care and management of her stroke risk factors, but ten years later she is a Mom of two wonderful young men, who now travels the country as a consultant to train teachers.

Simply because someone recognized the signs of stroke and acted "FAST", Amy has been able to impact countless others.
- How many swim meets has she attended in ten years, cheering on her sons?
- How many teachers has she impacted with her training?
- How many people were able to recognize the signs of a stroke in someone else because they heard Amy's story?

Ten years later, stroke care has been refined and tPA use, as well as advanced neurological intervention, are much more widespread. The key is for stroke patients to get to the hospital as soon as possible.

So what can you do? Don't ignore the warning signs of stroke. Even if you aren't sure, call 9-1-1 and get checked out. Remember to "Act FAST". The most beneficial stroke care is time sensitive.
Have more questions? Check out the Stroke Association or the American Heart Association.

Sunday, January 3, 2016

I made another Mom cry...and I'm so glad I did!

After a wonderful family getaway, I rushed to the grocery store to pick up food for diner and the coming week. Our kids have reached the age where they can be left home unless they have a burning desire to shop with me.

My first stop is always the produce aisle. As I was choosing my vegetables, I noticed a Mom with a toddler (a boy around 3) in one of those car carts.

Any parent knows those carts...beloved by children and IMPOSSIBLE TO STEER!!! The benefit of an entertained child (or two) weighs out over the muscle strain caused by trying to drive the cart.

Said Mom was picking out squash, and had placed it on the scale and gone to get a plastic bag. She stopped mid-step, and looked back at her son. "I'm sorry, did you want to help me?" He struggled to get out of the car, and Mom reached over to help him. She took him over to the scale, where she asked him to count the squash and they began to talk about how much it weighed.

I thought to myself "What an awesome Mom". I thought of the dozens hundreds of times I coaxed my kids through the grocery store with promises of "five more minutes", or a donut if they behaved. I thought of how few times I took the time to involve them in the process. I thought again, "What an awesome Mom". Anyone who knows me knows that I am a bit of an raging extrovert, and have been known to strike up a conversation just about anywhere. I didn't want to intrude on her Mom moment, so I went about my shopping.

Three aisles later, Mom and her car cart were coming toward me amidst the Taco Tuesday fixins. She apologized for her large cart. I told her she had nothing to apologize for, and that I had seen her in the vegetable aisle and thought she was an amazing mother.

With tears in her eyes, she said "My whole family has been sick. My younger daughter, me, my husband. We are finally getting out of the house after days at home and I feel like I have been so impatient with my son. You made me cry."

I told her again what a wonderful Mom I thought she was, and went about my shopping. All evening, I have been thinking to myself about how much more we could do to build one another up as mothers (or parents). So often we feel inferior because we don't make pinterest-worthy crafts, or we feel impatient, or we feel like we are barely holding it together.

All it takes is someone occasionally saying "you are doing a good job", or in my case a snowboard instructor who tells me that my son was a really good listener...It just takes a minute to make a Mom feel like they are getting it right. Why don't we do it more often????

Monday, September 28, 2015

I always said I make a good Wingman...

I'm dusting off the blog to share my latest passion. Funny enough, I blogged about being a Wingman in 2010, The meaning was a little different, but I've always said I make a good wingman, or "right hand man". Give me a task and I will do whatever I can to make it happen. After watching Melinda, a fellow triathlete, on her journey as a Wingman for some time now, I finally joined Athletes Serving Athletes. This organization helps disabled athletes experience the thrill of athletic competition.

I lost the passion for racing some time ago, but I love having a goal. Watching Melinda help some amazing athletes reach their goals got the fire going in my belly again, this time to pursue helping someone else complete their race. On a recent training run, one of the coordinators was telling me that hearing a disabled athlete speak about his races was truly incredible. I've had the pleasure of seeing Sean on each of my Annapolis training runs. When Sean speaks publicly about his experience, he says that even though he can't run, he feels the adrenaline before a race. He feels the pre-race nerves and excitement, and gets to experience the rush of the wind and the thrill of racing.

On my first training run as a Wingman, I ran with Sean, who gave me investment advice and critiqued my driving of the Jogger in which he was riding. This young man was brimming with personality. He shows up week after week for training runs, and loves participating in races with ASA. This article was written about Caleigh, another athlete I have had the pleasure of running with. If you wonder why this organization is worthwhile, this explains it. The amazing thing about these athletes? There isn't talk about race times, or equipment, or PRs, or competition (although some are known to tease the wingmen out if they "aren't going fast enough"). There is just a love of the sport... A love of being able to do something they might not otherwise be able to do. Each training run I have attended, there is great camaraderie between the athletes, wingmen, and families of athletes. Some of the parents run with us, other times they catch up with one another while their athlete is out running.

How does being a wingman work? Usually you run with 3 wingmen and an athlete in a jogger. The wingmen take turns pushing the jogger, rotating as the group determines. Each time I've run, we have settled into a rhythm of trading off the jogger. The pace isn't record breaking, but set to the comfort level of the slowest runner. In this situation, it is truly about the journey, not the time. I have left every training run feeling beyond blessed to have been given this opportunity. For all my runner friends, I encourage you to consider this... even one race in the next year could mean an incredible adventure for a disabled athlete.  The motto of Athletes Serving Athletes is "Together We Finish".

For more info about Athletes Serving Athletes, click here.

To visit my Athletes Serving Athletes fundraising page, click here.

Wednesday, October 29, 2014

Four Years Later...

This Saturday is the four year anniversary of my ectopic pregnancy. For some reason the anniversary is particularly raw for me this year. I have theories on why that is, but I think a lot of it has to do with our ability as nurses to think "things could always be worse". We minimize our own struggles because we see so much pain and struggle every day. Our situation can't really be that bad. I did this a lot in the days, weeks, and months after my ectopic. I explained it away, and told myself and anyone I talked to that it happened for a reason.  A couple months later, my hair was falling out, I lost some of the hearing in my left ear (it has never come back, and they never found a cause), and my SVT (abnormal heart rhythm) was flaring up regularly. I'm certain that the mind-body connection and the emotional stress contributed to these things. I would say it was at least a full year before I really dealt with things emotionally... I would also say that I continue to deal with this loss and I likely always will, as anyone in my situation does.

Here is what happened in 2010 in my words:
I found out last week that I was pregnant. We have two beautiful, amazing children. Lately, we have been enjoying the fact that our youngest is becoming more and more independent at 4 years old. We hadn't planned on a third, but apparently that plan was going to change. I selfishly thought about the things that I would put on hold for a few years. No triathlons in 2011... "Ok, I'll shoot for 140.6 when I turn 40" (that would give me 6 years). No more disaster medical team.... "Ok, that can be put on hold. I can still attend the trainings and keep up my skills." "We can't afford three kids in childcare...Ok, we will revise our schedules to eliminate before and aftercare for the two older kids." In a week, I had come up with a potential plan. It was a rough week. A lot of crying. A lot of guilt, for being shocked by this pregnancy when I know there are so many people who are trying so hard to have children. I felt tired, and nauseated, but tried to push through. Of course I started to become attached to this new little one.

On Monday, I started to feel uncomfortable. Pregnancy can make you uncomfortable, so I prescribed myself a dose of "Suck it up". Hours later, the pain was intense. (It should have been a sign when I put my jacket on the floor of my office and lay down for a few minutes trying to get comfortable). Eventually, my OB sent me to the ER. I was an emotional and physical disaster. I always feel fortunate to work with such amazing people, but even more fortunate to experience their skill and compassion when I needed it most. It took a ridiculous amount of pain medicine to get me comfortable, but they did. Tests showed that the pregnancy was ectopic (it was taking place in the fallopian tube rather than the uterus). This can be life-threatening, but thankfully they caught it in time. They were able to give me medicine and avoid surgery. It took an overnight stay to get the pain and nausea under control. The medicine (methotrexate) is a chemotherapy agent. It stays in my system for over a week, and causes nausea and other symptoms. I still have a fair amount of discomfort, but it gets a little better every day.

Three days later, I don't think I've begun to process it all. I went from thinking about how life would change with a baby, to not being pregnant in a week. I know I need to grieve, but I think I am too emotionally exhausted to be there yet. I do know that I don't have control over when it will happen, and just have to let things come as they may. 

Above all, I am thankful for the love of my family and friends. Tommy has taken time off to take care of me, the kids have kept their fighting to a minimum, and everyone has been so wonderful with their offers for help. I couldn't ask for more. I am sure there is some lesson in all of this for us, I just don't see it yet.

Four years later, I still haven't figured out that lesson. What I do realize and appreciate so much more is the loss experienced by those who lose a pregnancy. While Tommy and I weren't trying for a third child, it was still a loss, and it catches me off guard at unexpected times. Perhaps the lesson is that the loss has to be acknowledged. Sometimes we have to sit with it, no matter how hard that is, and let it be felt. And we don't always have to live in a world of "could be worse" and "things happen for a reason". Sometimes, things can just suck for a while... and then we have to pick up and give thanks for the amazing things that balance out the loss.