Tuesday, December 15, 2020

Why I Will Get the Covid-19 Vaccine

 Disclaimer- this is my opinion, based on facts I have acquired. It is only my opinion. It is also the opinion of a Nurse Practitioner who has cared for countless Covid-19 patients since March and lost so many whose families shouldn't have to be mourning a loved one.

Why am I getting the vaccine? 

  • Because the people in charge of vaccine rollout are nonpartisan scientists who just want to do the right thing for people.
  • Because the COVID-19 vaccine is based on the MERS-COV vaccine that was in development several years ago
  • From the CDC: "The U.S. vaccine safety system ensures that all vaccines are as safe as possible. Safety is a top priority while federal partners work to make a coronavirus disease 2019 (COVID-19) vaccine(s) available."
  • What are the side effects? Pfizer has run tests that include more than 44,000 people. An FDA analysis of the vaccine's safety and effectiveness on people aged 16 and older found "no specific safety concerns" that would preclude the vaccine's use. Some mild to moderate side effects are common — mostly swelling, pain, redness at the injection site, fatigue and sometimes including fever that resolves within about 24 hours. link here
  • The American Nurses Association and American Association of Critical Care Nurses recommend vaccination 
  • Because healthcare providers are weary. We are tired of somber phone calls to family members for days on end. We are tired of being the only ones to bear witness as a patient with Covid dies. We are tired of fighting a battle we know we will often lose. Because, as a colleague said, "we keep coming to work because THERE IS NO ONE ELSE". 

Sunday, June 14, 2020

A Letter to My Grandmother





I wrote this letter and mailed it on May 19. I hope our grandmother was able to read it or have it read to her and that she understood it. I am sharing because I think our ability to get through our current crises has been forged by those who raised us, the grandparents who lived through World War II and grew up in the time of the Great Depression. The parents who marched for equal rights. The "Greatest Generation" is just that for a reason, and we need to reflect on that reason and draw on it as we find our purpose in the "next normal".

Dear Grandma Jossi,
I started writing this letter on April 29th, and then got sidetracked with work and motherhood and so many other things. After the call tonight that you had either a stroke or mini stroke, I knew I had to finish it. Thankfully Mere and I were able to hear your voice and even though you have some expressive aphasia, you are still undoubtedly you.

Whenever I have described you and your character, I think about how you were born in the time of the Great Depression and how it shaped you. You always saved (you were worried we thought you were a hoarder, but you were an organized saver). You certainly bought us material things (we waited for your visits to go to the mall), but you gave us far more in experiences. Trips across the country, to Gettysburg, to Florida. 

You taught us that some pots and pans, rice, and water on the back porch can be the most exciting science project. 

You made “Huckleberry Finn” narrated by Dick Cavett interesting, even the 465th time we listened to it driving across the country. 

You and Grandpa taught me at the age of 10 how to pull up at a campsite and make friends. If there weren’t kids my age you taught me how to find my own adventure.



As we experience COVID-19, we have technology and food delivery and so many things you didn’t have growing up. We also have fear, and uncertainty, and worry that those we love will become sick or lose their jobs. I feel like our generation is finally understanding what it must have been to grow up during or shortly after the Great Depression, and what it was to worry about loved ones overseas in World War II. Only our battlefront is here at home.

When we talked recently about one of the historical fiction books I sent you (about amazing women in World War I), you told me “I love stories about women who kicked off their dancing shoes and put on their boots and got things done.” You are one of those women, and you have raised us to be those women. I came across these pictures of you and they make me think of what an amazing and strong and beautiful woman you are.

One of the hardest parts of this pandemic has been caring for patients who can’t have their loved ones visits. Our nurses and staff have become their families. I am so thankful for the staff there at Lifecare who are taking good care of you.
                          We love you very much

Saturday, April 25, 2020

How COVID is Changing My World as an ICU Nurse Practitioner

This is my story, our story. I share it not for recognition, or gratitude, or pity. I share it so you understand what it is to work in a community hospital, three blocks from my home, during this pandemic. So that the social distancing and the home isolation are worth it for you. So the empty shelves at the grocery store and the mask you have to wear are a little less bothersome. So my children missing major milestones in their adolescence is worth it. So that the days upon days of fighting a virus we don't yet know or understand are worth it. So that we remember, when we start to find our new normal.

Nurses and front line healthcare providers (nurse technicians, phlebotomists, providers, radiology technologists and so many more) have long faced violence from patients and their families as one of our biggest threats. This isn't just violence from patients intending to do harm, but those who are confused or have neurologic impairments such as dementia and do not understand the implications of their actions. This epidemic (a strange word to use now to describe something that isn't infectious) has gained more recognition, advocacy, and even legislation over the past several years. The American Association of Critical Care Nurses issued a statement on workplace violence in 2019.

Six months ago, if you asked any Nurse the biggest risk they face at work, a vast majority would have answered workplace violence. These incidents are far more frequent than the lay public would likely imagine (OSHA reported that from 2002-2013 incidents of serious violence were four times more likely to occur in a healthcare setting than in private industry).  Suddenly, we have been catapulted into the front lines of an entirely different threat. "Front line" infers a battlefield, and for Nurses and other healthcare providers and hospital workers, this is truly the closest thing to battle those of us who haven't served in the military will ever know. I say that with all due respect to those serving, knowing the threats they face on deployment every day. This is the first time each and every one of us goes to work every single day worrying about the threat we face.

"Will this be the day I get sick?" "Which of my co-workers is most at risk of getting sick?"
"Do I need to worry about this sore throat or am I just run down?"


Sitting at dinner the other night, I told my children that the way their world feels right now is much like we felt in the days after 9/11. My daughter is a senior in high school whose important milestones have been put on pause for this pandemic. I told her this is the part where we wonder what changes to our daily lives will be indelible, and what will "go back to normal".

There are things I hope do become ingrained in our healthcare culture. Our colleagues have become our "battle buddies", as we invest in keeping each other and ourselves safe and healthy like never before. Staff from other areas of the hospital have folded into our ranks, sharing their skills and strengths to make our team even stronger. The relentless teamwork, and the moments of pause that we have taken together, to laugh or cry or just debrief, are things I hope we never lose. The community support...the meals, the headbands with buttons to hold our masks, the care packages, the people who have recovered from covid and are donating plasma ("liquid gold"). My friend Jim Mazzara, #rovingDCpiper, playing bagpipes around the area to lift spirits, and serenading a new mother and her infant with "Happy Birthday" as they left our hospital. Each gesture has been appreciated in ways you cannot imagine. We thank you. We appreciate you.




There are also things that have changed which make our jobs infinitely harder, mentally, physically and psychosocially. We are professionals grounded in evidence. "Evidence Based Practice" has become our mantra. When a patient suffers a heart attack or heart failure, I always tell them "cardiologists love research, and we have a recipe for everything. I may not know the exact specifics yet, but I know the ingredients we need to help you get better and stay out of the hospital." It is said that it takes as many as 17 years for research to be fully translated into practice. Suddenly our practice is changing daily. There is little evidence and we make the best decisions we can, with the available information, guided by experts in infectious disease and critical care. We are fortunate in Maryland to have the benefit of lessons learned from colleagues in New York, New Jersey, Italy, China, and so many other places. We had time to prepare, to empower ourselves with knowledge of their successes and lessons learned. We have had to constantly pivot, then educate providers and front line staff on changes in personal protective equipment, patient management, rules, regulations, you name it. That is just the logistics and protocols, then you get to the human part of what we do....

For decades, it was thought that families should not be present in the Intensive Care Unit (ICU) during invasive procedures or cardiac arrest. Researchers slowly chipped away at this misconception, showing that family members have a better understanding of what happened to their loved one when they can be present at the foot of the bed, or outside the room, with a member of hte team explaining what is happening. They see that everything was done for their loved one, they have a better grasp on the reality of the situation than they would sitting in a cold and unfriendly hospital waiting area. We worked to change culture, to convince colleagues that family presence did not increase liability, that we could still talk through our plan of care and discuss treatment options and advanced life support protocols in front of family members. Family presence is an area in which our small community hospital has long excelled.

Prior to Covid there were no "visiting hours"; families (biological and chosen) were allowed in our ICU and nursing units 24/7 as long as there was no impediment to patient care. Family members were encouraged to participate on daily rounds in the ICU, and if they missed the rounds at 9:30am they were repeated by our Nurse Practitioners and Physician Assistants at 9:30pm and they could participate then. Now each family must be updated by phone, and despite requests for one spokesperson, multiple understandably concerned family members call the unit inquiring about their loved one each day. These calls and video chats are their only point of contact, unless their family member is able to talk by phone. We ask family members to email photos so we can make posters for each patient, to provide them something familiar as they awake delirious from the haze of sedation and mechanical ventilation.

Covid has put us in a place where there is no physical family presence. We are the hand-holders, the cheerleaders, the person standing at the bedside shedding a tear as a patient dies. The ones giving thumbs up EVERY SINGLE TIME we walk by the room of a patient who is awake and improving. We have always been those people, but we didn't replace a patient's family. We supported them at the bedside and when they were not present we provided whatever the patients needed. Now there is no one else. It is only us, the healthcare providers, who can hold hands, soothe our patients, give them dignity and respect, bear witness at the end of their lives. And WE MUST bear witness. It is unspoken that no patient should die alone. We hold their hands, we tell them how much they are loved by their family, and that their family will get through this difficult time, we pause to recognize the person that existed before COVID, before the tubes and lines, before we became their extended family. Then we call their family again, and let them know that they weren't alone, that we were there, that (if they were religious) we prayed with them, or sang to them, or played soothing music. That someone who cared was there at the end, to bear witness.

After hearing a Public Health Service officer speak about a mural used to memorialize Ebola patients in Liberia (those who survived and those who perished), I shared the idea with our staff. Chaya, a friend and Nurse Practitioner Colleague, went to work with her art supplies and created a foundation. Our staff then began to contribute, remembering each patient we have fought to save, regardless of outcome. The painting has gained more flowers and stars since these photos, a remembrance and a moment to pause as they are painted.



















Whatever your job, imagine cutting holes in a trash bag and putting it on yourself like a poncho (or like a wrestler trying to drop weight). Then put a tight-fitting mask on your face, a plastic eye shield, and gloves and go about your day. It is hot. It is sweaty. You start to discover pressure points on the bridge of your nose. You are often in a room with a "scrubber" that is used to filter the air (imagine the loudest industrial fan you can, then imagine louder). To communicate with people outside your patient's room you write notes on a whiteboard "Need a gown." "Need a new Levophed drip" "Need a boost", then knock on the glass door to get the attention of someone outside the room. Change in and out of this outfit without touching your face, approximately every 30 minutes. While in this garb, put your cell phone or tablet in a ziploc bag, and attempt to face time with someone while standing right next to that industrial fan.

We have been told this is a marathon, not a sprint. I ran one marathon. In 2008. It was 26.2 miles. I beat Oprah, which was my one goal. A marathon is 26.2 miles. It is finite. Even at mile 25, when you have hit the wall and think you can't go on, you KNOW you only have 1.2 miles to go. This is an endurance race in which the finish line keeps moving. It is not finite. When you hit the wall, you have to have your moment (and I have definitely had them- tears, frustration, fatigue, sorrow, illness), and then you have to lean in and get back to it. Sometimes it takes a kick in the pants, or a boost from a colleague or loved one. Whatever the motivation, you get back to it. For your patients, for their loved ones, for your colleagues. Because it is your calling. Because if you were sitting at home you would want to be there, helping. Because you are a helper. Even when it is hard. Even when it is risky. Even when there is no finish line in sight.

When the curve flattens and things "go back to normal", we will still have COVID patients who are days and weeks from leaving the hospital. We will still be fighting this battle as things start to reopen. The outside world will move back toward normal but ours will still be filled with COVID. The patients who are still healing, and then the worry of resurgence. But it will also be filled with so much more- with the relationships we have forged, fighting this battle together, with the people who have supported us, with the reminder that we are called to this work, with our pride in being healthcare providers and hospital workers, with the memories of patients we have gotten through moments we thought they wouldn't survive who are now home with their families. As we whisked a terrified patient from a medical floor to the ICU with his oxygen level plummeting, my colleague Rachel, a Physician Assistant, provided him an explanation of what would happen next, and words of reassurance that have since been repeated countless times.
"This virus is strong, but so are we."



Tuesday, October 15, 2019

Chasing Zebras: An NP Perspective on Being a Patient with an Undiagnosed Illness


When making a medical diagnosis, providers are told to rule out the "horses" before looking for the "Zebras". A zebra is defined as a very unlikely medical diagnosis. A good example is jumping to the conclusion that a mild headache is a brain tumor before ruling out other causes. The health care team should always rule out the life-threatening potential diagnoses associated with a set of symptoms, but also be looking for the most obvious and common causes of those symptoms. When none of the standard explanations fit, then we begin looking for Zebras.

Many of my family and friends know my saga... Numbness and hyperalgesia (increased sensitivity to pain) that began in early July. It started on my right side (first my face- leading to a diagnosis of Bell's palsy, but quickly down my arm and leg). Tests were done to rule out all of the scary or life-threatening things (Lyme, MS, Guillain Barre, Myasthenia Gravis, Meningitis, Neurosyphilis , HIV, etc). My neuro exams were always normal. The only thing abnormal was sensation. The symptoms spread to my left side and everything felt incredibly heavy. My legs and cheeks have been the worse. It isn't noticeable to others but for weeks it felt like it took immense effort to smile. My tongue was numb first on the right and then bilaterally, and any worsening of symptoms led me to feel like someone under the influence of alcohol who was trying to pretend I was sober. It took great effort to feel like I was speaking normally. After a while, these symptoms make you start to question your own sanity. None of them are testable or visible to others. I asked my doctors repeatedly if they could be psychosomatic but the feeling was that they were related to a physiologic insult. My EMG (Electromyelogram- fairly painful test of the electrical activity of muscle fibers) was normal. My MRIs and CT scans were normal. The only working theory was that I had developed a post-viral neuropathy which meant a cold virus I had before these symptoms started somehow affected my nervous system. The fact that it was on both sides and over the entire body was unusual. The neurologist told me that we likely wouldn't find the cause, but that it should get better over a period of months (from my reading I knew it could be up to one year or more).  

By August we were looking for Zebra diagnoses that explained my strange constellation of symptoms. At this point I was crowdsourcing my diagnosis (to colleagues, laypeople, everyone)... I was willing to consider any and all potentials and kept a running list of the things we hadn't yet tested for that we should consider. I was also working on accepting that likely we might never know the cause or how to make it better aside from sitting and waiting.

It was also in August, the really bothersome symptoms started- I had episodes randomly in different places all over my body of feeling like there were fire ants crawling on my skin, or of a burning/itching sensation. It wasn't traveling along a specific dermatome or nerve path. It was completely random and uncomfortable. I tried Gabapentin which I eventually stopped because I felt foggy all the time. I told my colleagues I felt like I had "gone from an A student to a B student". In addition to the fogginess I had a rising anxiety. I often felt like I was crawling out of my skin. It reached a fever pitch in September. I was able to exercise and physically could do everything I did before July, but the symptoms were getting the better of me mentally. My primary care physician was amazing and helped me navigate all of this. In mid-September, after many conversations, I mentioned to her something I hadn't thought of before: ever since last October, when I exercise and then go out into cool air, I break out in hives. The first time it happened it was disconcerting, but it happened a few times over a several month period so I didn't think anything of it. My PCP immediately suggested I see an Immunologist/Allergist who works in the local area and likes "zebra" cases.

At the same time, I took more control of the things I could control. I was back to baseline in my workouts. I started eating an autoimmune diet (thanks to the suggestion of a dear friend), and began acupuncture treatments. Two weeks ago, I saw the immunologist/allergist, who told me that my case was definitely "weird" (in a nice, "You are an NP so I can tell you that you are a zebra" way).  I told him about the numbness and the painful symptoms. Then I added in the hive piece. He immediately said "You have cholinergic urticaria". What the heck is that, you ask? It is an inducible hive disorder in which hives are causes by environmental stimuli (heat, cold, exercise, etc). The Mast Cells in the body (which are important in immune response and allergic response) are involved in the reaction, releasing histamine in the skin. (Too much of a good thing with those Mast Cells in this case).

What he said next really had me intrigued: people with chronic hive disorders often have a prodrome (an early symptom that indicates the onset of a disease or illness). This is often described as transient and patchy, either itching, burning, or painful sensations. The fix? An antihistamine like Loratidine (Claritin) every day to prevent the histamine release. He told me to try that for two weeks and if the painful symptoms improved, we know they were caused by the chronic urticaria. He said he couldn't fix or explain the numbness, but again reiterated there was nothing to suggest it was life-threatening. That said, there was hope that perhaps we had an answer to the painful symptoms. Two weeks later and the claritin is working. Today I had an episode of post-workout hives but I think that was in part due to eating some new foods I hadn't been eating on the autoimmune protocol diet. 

So apparently I have two unrelated issues, and the numbness and hyperalgesia have been making the hive disorder feel a lot worse than it had previously. Even on a day like today when the symptoms flare up a little, at least I know we have a path and a plan. I wouldn't have chosen to be a Zebra, but I'm thankful for persistent healthcare providers who helped me get to the bottom of things. (At least some of the things, since the numbness and hyperalgesia are still an issue, but I am hopefull they will improve).


Tuesday, July 16, 2019

I love mysteries... I don't love being one

In 5th grade, my parents met with my teacher because they were concerned that all I would read was Nancy Drew books. The original Nancy Drew series, the 80s reboot "Nancy Drew Files", all the Nancy Drew/Hary Boys crossover books, and the choose your own ending Nancy Drew books. I wanted to be Nancy Drew. The teacher told my parents that my reading ability was not in question and as long as I was devouring books I could read whatever I wanted.

As a pre-teen and teenager I wanted to be Nancy Drew. It was years into my nursing careeer that I realized solving medical mysteries brings me a lot of joy, and that in my own way I get to Nancy Drew the heck out of things. What clniician doesn't love getting thattidbit of medical history that no one has- that nugget that leads to an unexpected diagnosis. Pulmonary embolism is one of my favorite diagnoses because it often mimics other things. For my healthcare friends, there is a great book entitled "Mastermind: How to Think Like Sherlock Holmes" that lends some insight into looking at things differently. 

So on to my medical mystery.  I'm sharing because if you work with me you have likely seen me as a patient this week, and I am open to other thoughts/suggestions. Here are the highlights:
- After fighting a cold (sore throat, cough, etc) for a week or so, on Saturday July 6  I noticed in the morning that my right cheek felt numb. When I say numb, I dont mean without any feeling, more that "pins and needles" feeling you get when novocain at the dentist is wearing off or a limb is waking up from being asleep. My motor activity was still intact. No slurred speech, no facial droop. My healthcare friends will understand this: I knew I would not consent to tPA just for this facial numbness, so I didn't rush to the ER. I was thinking perhaps Bells Palsy. I eventually went to the ER, got lab work including testing for Lyme, and antibiotics for possibly Lyme.
- Sunday July 7- I woke up and the numbness was still in my face but also down my arm. ER trip #2. CT and CTA (CT scan with contrast to look at the blood vessels) of my head and neck. Brain and carotids looked great. Then an MRI of Brain, C, and T spine. All totally blissfully normal. I was now on Valtrex in the event it was shingles or another viral issue, and Doxycyline. At this point we ruled out some of the scary things: stroke, MS, carotid artery stenosis, ALS, and a variety of infectious disease.
- Wednesday July 10- woke up and the numbness was going down my leg (now on my entire right side). A neuro exam showed I'm actually hypersensitive to pain but have the constant pins and needles (the good news there is I don't have to worry about getting an injury and not feeling it).
I ended up back in the ER so my very awesome neurologist could assess me, and they ordered a Lumbar Puncture. My cerebrospinal fluid was normal, except for a high number of lymphocytes (a type white blood cells) which suggests there had been an infection. 
-Thursday July 11- Developed a wicked spinal headache from the LP. I have a pretty high tolerance for headaches after 30+ years of migraines. This was pretty horrendous. Caffeine and hydration are the antidote. The alternative is a blood patch but we saved that as a contingency if the conservative management didn't work.
- Saturday July 12- Woke up to pins and needles on my left side. (Not nearly as bad as the right, but there nonetheless). Saw the neurologist and since motor function and reflexes were totally intact there wasn't really anything to do but wait. He still thinks this is a post-viral syndrome that will burn itself out. 
- Monday July 15- the spinal headache was still unbearable. Went to the ER where we tried IV caffeine (IV caffeine...all the coffee drinkers reading this are thinking yeeeesssss!). It was about the equivalent of 9 Mountain Dews. I was shaky but the headache persisted. 
Image result for mountain dew
So that led us to the blood patch. Not my idea of a good time but at some point you just want to feel better. 
Image result for blood patch
Tuesday July 16- My back is sore for sure, but manageable. The numbness is still there. It hasn't gotten better since it started. As I've described to alot of colleagues and friends, my tongue feels funny so when I speak I feel like an intoxicated person who is trying to sound sober. (But my speech actually sounds normal). The ongoing opinion of neurology is that this is the effect of a virus I had previously and it should hopefully improve over time.

Lessons Learned
- Sometimes you have to find peace with uncertainty. This is definitely frustrating but there hasn't really been an alternative option. We've ruled out all of the big bad things, so that is the silver lining on which I need to focus.
- 4 ER visits in 8 days starts to make you feel like a crazy hypochondriac. Friends and healthcare providers who validate your medical concerns help you to feel less crazy. (and yes...I have asked multiple providers if this could be stress/psychosomatic and no one believes it is).
- The simple gesture of a doctor or nurse pulling up a chair to talk to you when they obtain a history or perform an exam makes all the difference in the world. I know how busy nurses and providers are, but so many have taken the time for me this week. 

So many thank-yous to my hospital family, my actual family, and my amazing friends. In the grand scheme this numbness isn't a huge deal...but the journey to ruling out the big bad neuro insults and the ongoing addition of symptoms definitely led to a few stressful days. 

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!