Why I worry about my marriage

My husband and I don't always get along. He is a cut and dried introvert. I am somewhere in the middle between introvert and extrovert. I like to keep busy. He likes to be idle.

Mostly we deal with these differences alright. I keep busy, I join groups, I meet people, and I get involved (hence, my quilt guild, the church, the wind symphony). He rests up at home on his time off. He watches a lot of TV. He plays games on the computer.

Sometimes we run into conflicts, and today we had one. I decided I did not want to go to church today. It is never his decision whether we go to church or not. He goes most of the times I go. If I don't want to go, he doesn't go. Fine. That's just the way it is. So, I got busy around the house, cleaning up, and starting to work on my project to redecorate the basement. Mostly I worked on this alone. Occasionally I needed some help with a few things.

Apparently my redecorating and planning has upset him. He doesn't want anything to change downstairs. Piles of clutter is fine with him, as long as his speakers are aligned properly. He doesn't care if we still have boxes from when we moved in sitting around. It's important to keep those floppy disks, even if there isn't a floppy disk drive in the house. It's important to keep the boxes from software we don't use any more.

And then, what really gets me, is that he seems to want to have us sit around the house all day until he's ready to go out and do something. Then he's ready to go. Did he mention any plans to me earlier in the day? No. So, I'm in the middle of doing something else and I'm supposed to suddenly want to go out and do this or that.

He's annoyed when I don't want to drop what I'm doing. In fact, I think it devastates him. He takes the rejection as if I reject "who he is." Or something like that.

This is what happened today. I was working down the basement, and I came upstairs ready for a break and for lunch, and he says to me that he wants to see a movie. Fine. He did not tell me when, which movie or what. I am supposed to want to go. I declined the invitation; I had got in my mind all kinds of things to do around the house today, since I had no input from anyone else. He didn't tell me earlier this morning that he was thinking of going to the movies. He let me know 45 minutes before show time.

When I declined, I got the emotional cold shoulder, like I plan my day purposely to squash his plans. I keep busy just so he won't be able to do things. Well, he doesn't make plans or if he does, he doesn't tell me about them until the last minute. It seems like he expects me to laze around all day until he comes up with something to do. He may or may not come up with something to do. Who knows.

I think he might like me better when I am depressed. That's when I laze around.

Unfortunately, I don't like me when I'm depressed.

I worry about my marriage because I can tell my husband is thinking that if I reject his idea, I don't really "get" him, after all. I don't support him. I don't agree with what's important to him, so what's the point? If I want different things, then we aren't the same after all.

I think he thinks we should always be together in our free time and we should never fight. I think he thinks I should be able to intuit what he is feeling and thinking, if we were truly compatible and if I truly loved him. I think he thinks we should want the same things all the time, and want them deep down to our souls. It's not good enough to do something I may not like so much because I love him and want to make him happy. It has to be my heartfelt desire as well or else it's a lie.

I don't agree with this. I need my time away from him. I think having different goals is OK. Most of the time we're in agreement, anyway.

I worry about my marriage because maybe one day, he'll convince himself that the emotional torture I put him through is not worth the benefits of being married. His biggest fear with come true - that I'll say I don't really love him after all. And he'll leave.

My worries are mitigated in some ways because I don't think he will do it. I don't think he has the courage to make that decision on his own. I think sometimes he goads me to try to force me to make that decision for him - then he won't be the bad guy, wanting divorce. I will be the bad woman who never really loved him anyway. I think he'll try to make it bad enough for me that I'll leave as an act of self-preservation.

Sometimes if you look hard enough, you will find what you're looking for. Whether it is there or not.

Personally, I love the guy, and I think we're pretty compatible. We are not perfect together. I don't think any couple is, really. Most of the time I feel appreciated and valued. I try to do the same for him, but I admit, I'm not perfect. I build him up. I encourage him. We laugh together quite a bit.

Marriage is hard. It's a little easier after 10 years, but for me, the uncertainty doesn't go away.

After the Holidays

I spent a week in northern Arizona with my in-laws. It went very well and we had a good time. The group consisted of myself and my husband, my mother and father-in-law, and my brother and sister in law and their two kids.We were there from Sunday through Friday and that was a nice length of time.

My mother in law is an artist and she makes beautiful jewelry and accessories. I was fortunate enough to receive some earrings and some home items, including a wine stopper, a dish and some beaded utensils.

My husband got me a new computer! I'm so excited - it's a new iMac, so much faster than my Mac Mini. It's sleek, it's cool, it's pretty, and it's more than functional.

I also got a new book, the second in the series of biographies of Eleanor Roosevelt. She was a remarkable woman. I am not much of a reader, really, but this author (Blanche Wiesen Cook) writes well and makes the material interesting. I am somewhat surprised as I read this book at how things were for women in the 1920s and 30s. We have come a long way. Eleanor Roosevelt and her contingent were instrumental in changing how Americans regarded women.

Travel

The traveling out to Arizona was pleasantly uneventful. The flights there and back were smooth. There were two stressors on the way back. The rental car company made us fill out an incident report for some supposed scratches on the bumper. I wonder if they targeted us? We didn't hit anything or scratch anything with the car while we had it. They might target us because we're from out of town. Well, we filled out the report claiming we did nothing and I took pictures of the entire car exterior. Just in case.

The second stressor was that the "babe" who sat next to us on the plane apparently thought she was better than the regulations regarding use of a cell phone on the plane. We got her to stop eventually, but she was pretty nasty about it. Actually, my husband talked to her about it and she snapped back at him. I wish I could have said something. I'm such a wimp.

Family

Overall I like my in laws. I couldn't have asked for better family, all things considered. However, they are not the family I grew up with and as such, their habits are foreign. I am foreign to them, as well. This causes stress. So, leaving after 6 days was a good idea.

My brother in law doesn't talk much. He's hard to relate to. My father in law and mother in law talk a little too much. My father in law likes to goad people with purposely false or misleading statements, just to raise an argument. His comments aren't mean spirited, but they get annoying after a while.

Both parents in law raised a lot of issues with not communicating with them "enough." I defended myself because I actually do send them emails about once every month to 6 weeks with general news, pictures, or whatever. Since we don't have kids, our lives are not that interesting to relatives. My husband doesn't communicate with them hardly at all unless there is a specific purpose. For example, I had to ask my husband to tell them what our travel plans were. We knew what days we had reserved at the resort, so I guess, to him, it didn't matter exactly when we arrived or left. Why did they have to know? While in Arizona, I deflected all attempts at guilt from the parents in law. I get few rewards (i.e. emotional goodies) by maintaining the relationship with them all by myself. Therefore, I am not going to do all the work. I will do some, and I do, but if they want to feel close to their son, it is not my responsibility to enable it.

This family does not like plan or make decisions. This drives my sister in law and me crazy; however, after 10 years we have both adapted. We usually plan for everyone. If they don't like it, I'm more than willing to negotiate, but if they don't speak up, tough. At first, I felt like I was being trapped by the family -as if they were putting me in the position of guessing what they wanted to do, then being responsible if they were disappointed or displeased. I got over that.

Another thing about this family is that my father in law likes to drive. All the time. Anywhere. If it's a dirt road, and he doesn't know where it goes, he'll take it. He is not the best driver to suit my tastes. He steers rather jerkily at times, and he likes to drive fast on twisty curvy roads up the mountainside. We try not to let him drive all of us too much. My husband and I were kind of trapped because we didn't have any excuse to let us drive. My brother in law and sister in law had such excuses - the child seat was in their car, and two of them get car sick if the driving is not smooth.

Additionally, I think the driving issue has to do with power. Dad holds on to his patriarch status this way.

Somehow, I managed to negotiate to allow us to drive to the Grand Canyon on our outing. That was remarkable.

I paid for that negotiation with some snide comments, but I made a concerted effort to let them roll off my back. Dad wasn't too cruel to me overall. No one else would have stood up to him.

And, we did let him drive on the other days!! It was only moderately terrifying....

Enough Complaints

For the first time I can remember, I really felt like I was a part of the family. It is not their fault or anything - in general, I have difficulty feeling like I'm really a member of a group. I'm not sure why. I got to make the cake for dessert on Christmas. We brought the wrapping paper so we had nicely wrapped gifts on Christmas. I helped make decorations for the "Christmas Tree" (a decorated artificial birch tree in the villa). That was really nice and made the trip worthwhile.

So it was a Merry Christmas. It was different from others I had experienced before.

Back to real life again.

Mixed Nuts

A few thoughts before Christmas. I will be out of town for the holiday, leaving later today.

My husband gave me a new Mac for Christmas! I'm very excited - I had been using a Mac Mini for the past 3 years and I was outgrowing it. I now have a 20" iMac. Way cool. Now, if only it can support running Word, Excel, Adobe, and safari all at the same time while I'm working on the quilt guild newsletter.

Husband liked the gifts I got for him - a pub sign custom made with his name, the Blade Runner complete collectors edition Blu Ray DVD set, and getting the poster custom framed. I have one more thing for under the tree on Christmas day. It will make the day more fun. He doesn't know about it...unless he happens to read this entry before Christmas. He's an ethical guy. He won't.

It is so dark these days!! I have to keep reminding myself that the days are getting longer from today onward, to keep from getting too depressed. It is the time when I spend more time in the basement, which is where my sewing studio is located. Yesterday, even, I got four more blocks done on the quilt for our bed.

Now that Christmas is almost past, it is time to think about my home projects for the winter and spring. I would like to:

1. update the kitchen with a new dinette and new cabinet hardware


2. paint the family room


3. redecorate in the basement


4. improve the organization and neatness of the home office


5. have a yard sale in the spring

Ambitious goals. At least I don't have to do yard work this time of year. I hope I get one or two of these done.

Enough chatter for now. Hopefully I'll post again while I'm on vacation.

Christmas Gifts

I like giving and receiving gifts. It is fun to buy for someone, to think about someone and think about what would delight them. I don't usually feel obligated to buy gifts, and that makes it more fun.

I also like to send Christmas cards. For some of my friends, it's the only time I contact them and they contact me. Much to my dismay, Christmas cards seem to be going out of fashion! Emails are nice, but they aren't the same as getting a real card with real writing on it. I even like the Christmas form letter. It's fun to hear how people are doing. I like to sign all of my cards and I like to decorate the envelopes a little when I send them. Last year I custom-colored rubber stamps with special markers. This year I found some snowflake decals with super-fine glitter.

I have received some special gifts so far. My mom always goes overboard and buys all kinds of stuff. Most of the presents she gives are very thoughtful, unique and fun. Occasionally they are just weird. This year, she made me a cross stitch picture about quilts. It's beautiful. She also sent a perfume bottle, a cookie cook book (Gooseberry patch!), a pretty kitchen towel, a molded soap in the shape of a frog (it's really cute), and two books about dogs. My husband got a cross stitch picture of Eeyore. I like everything she sent this year.

I sent Mom a festive bouquet of flowers and a pretty needle case for her cross stitch needles. I found the case at a quilt shop in New York City when I went there in September. It's a small tube , about the size of a tube of chapstick, decorated with had-crafted flowers made of Fimo or Sculpy clay. My Dad got a gift basket of Rocky Mountain Chocolate Factory goodies. He likes chocolate. A lot.

My niece Adia got a bed quilt. (See previous posts.) My niece Kendy got my old sewing machine (not the antique) and sewing supplies. I don't know what we're getting my nephew Dexter. He's only 5. Any toy will do, and we will see him on Christmas so we can wait til the last minute. We sent povitica (see www.povitica.com) to one set of brother and sister in laws. We have a hand-crafted bottle stopper for wine bottles for another set of brother and sister in law, the ones we will see at Christmas.

I gave my sister Marcia a pair of dichroic glass earrings I found at an art fair last summer. My mother in law will get a similar pair of earrings in a different color. Marcia like purple. Mom in law likes oranges.

My friend Ann got a pocket briefcase portfolio. She's a big-wig architect, and can probably use some nice business accessories. I even had it monogrammed for her! She sent me a fun Quilt kit and a gift card for JoAnns. She also sent pancake mix from Aunt Sarah's, which is a pancake house in Virginia and North Carolina. It's my favorite place to eat breakfast when I visit in Virginia.

I gave my boss a pot of crocus bulbs that she can force in the winter.

We received some edible goodies from my aunts and uncles, including Cheryl's cookies (those are *long* gone) and mixed nuts. My Mom and Dad in law sent us goodies from "Heart of the Desert" pistachios. They make the best green-chile pistachio nuts.

To me, gift giving is a way of expressing love and care. My mom is the same way - I guess that's how I learned it. I have long since abandoned any guilt or competition in gift giving....as a result, it is fun and satisfying. Several years ago, my brother and his wife sent out letters to everyone stating they no longer wanted gifts at Christmas and they weren't going to send any more to us. I found that very hurtful - not because I wasn't going to get anything, but because it seemed to eliminate a way of contacting and interacting with them. I expressed this to them, but I do respect their wishes. And ever since, we do interact even less. So be it.

Fortunately, they "let" relatives give gifts to their daughter, my niece Adia. I try not to make it too excessive in cost. Handmade things work well....or at least I think so.

I should write about my brother and his wife. They are odd birds, to me. Good people, mind you, but in some ways, just so weird.

Then again, so am I. So is my sister.

I haven't mentioned what I have for my husband. I might post later on this - don't want to spoil the surprise, if he happens to read this.

Merry merry Christmas!

On Depression

I struggle with depression every day of my life.

Some days it's easier than others. Today I'm having difficulty.

I think ever since I was an adolescent I had depression. To some degree I was taught to be depressed by the women in my family -it runs in the maternal side. That probably means I have a genetic disposition for depression as well.

Regardless of the "fault" (a bogus argument), I have it and I deal with depression almost all the time.

How Depression Feels to Me

Lately, my depression is a giant empty feeling, wondering "what's the point?" While I have searched for meaning in this world, I often feel like I am nothing. The world will function fine with or without me. Depression is loneliness. Depression is hopelessness.

None of these feelings are particularly logical; that characterizes depression, too. Depression makes me want to die.

I do think about suicide from time to time. Now, don't worry, I do not have a plan, and I won't do it (see below). But the reason it comes up is that sometimes I feel that if I have no point, no goal, no meaning in living here, now, in this place...why should I even bother? Why should I continue to use up resources? As you can see, I don't glorify killing myself - if I were to do it, I wouldn't do it so that I'd be "famous" or some other grandiose bullshit like that.

Feelings of doubt and feelings of regret feel like torture to me. Disappointing my expectations is exquisitely painful. These are the feelings that I want relief from. A recent example is how utterly despondent I feel when I fail at placing an IV over and over again.

History

I started addressing depression when I went to therapy in the early 1990s. I expected to be cured of depression and anxiety, but this is not the case. Instead I learned tools to deal with it, and I learned to forgive myself and my family for being as imperfect as we are. I also learned to take antidepressants.

How I resisted taking these pills!! I thought it would change "who I am." In American culture, protecting one's unique sense of self and identity is highly valued, regardless of whether that self is good, bad, or indifferent. The pain of depression and anxiety beat me down and I finally agreed. I took Prozac. I was better.

While on the antidepressant, I found I was "lighter." By this, I mean I was not burdened by the little everyday challenges we all encounter as much as I had been. I seemed to bounce back from setbacks more easily. My therapist characterized me as having "less of an edge." I was delighted to find that my appetite decreased. I lost some weight (sadly, it was only temporary). I did better in my job, and I did better with my interpersonal relationships.

In fact, while on Prozac, I found my current husband and succeeded in getting married. I even improved my relationships with my mother, father, and siblings.

Why would I ever stop? The paradox of psych medicine is if they are working, you don't think you need them. Additionally, I stopped doing therapy after a while when I felt I wasn't getting much out of it any more. Without a doctor, you can't get Prozac, legally, at least.

There's more history of my return to therapy but I don't want to talk about that right now.

Coping

I cope almost every day. Some of the things I do to deal with it are the following.

Religion helps me a lot. I believe in a merciful God who loves me. I believe in a God who has a purpose for my life and because I am God's beloved creation, I am deeply compelled to respect that purpose, and I need to fulfill it. Perhaps my purpose is humble. Perhaps my main purpose in living has already been fulfilled, and now I am here only for the grace of God. Therefore, if I am thinking of ending it all, I reason that at the very least, I can feed a hungry person, clean a room, give some change to charity, or pray for someone. Those purposes are highly valued in God's realm. I believe that if I ever need to leave the secular world and its screwed up values, there is a place for me among the humble, the lowly, God's beloved children. For this reason, I will not kill myself.

You can relax now. Please don't call the authorities.

Keeping busy also helps. I got this tip from a magazine many years ago, and apparently it's from Eastern philosophy. If I am depressed, do a project. Sometimes I cook something nice (especially bread - I find bread baking very therapeutic). I work on my sewing projects. Sometimes I clean. Sometimes I shop or browse at a special store I don't go to often, or someplace that takes a lot of time to shop at (like Big Lots, or Tuesday Morning, or even Old Pottery).

Exercise works as well. I find yoga very helpful - I can concentrate on form and balance without the pressure of being perfect. Aerobic exercise really helps, but I have trouble motivating myself to do it. I also like to walk the dogs.

Introspection and journaling, such as this very blog, helps. I find it soothing and calming to express myself...in fact I would argue that it's necessary for me!!! In the past, I have used therapists to fulfill this need. I am getting tired of therapy - I am finding it somewhat self-indulgent at this point in my life. Many therapists have told me about the value of journaling, and I have resisted it up until now. It seemed like so much work! I suppose it's time.

My latest therapist (during nursing school) suggested a brief journal, using a tiny memo book, with one page per day. Only write one page with your thoughts and feelings at the moment. This technique actually worked for me.

Getting "outside" of myself is another strategy. It's hard to focus on yourself when you're helping someone else. As an aside, this is another reason why I became a nurse. How curious! A career change to promote my own mental health!!

Little perks and indulgences provide a sense of being cared for. The types of things that work are manicures, buying fresh flowers, getting my hair done, a massage, bowling, doing a "paint your pot" ceramic project, going out to breakfast, or seeing a movie.

Finally, being involved in music again has helped immensely. Singing is very uplifting. Now that I'm playing clarinet again, I feel like I am a part of something special. As long as I keep humble and not fall into the trap of thinking I'm superior, then I enjoy the experience and the blessing of participation.

Wallowing

Sometimes I wallow in my depression. I do my best not to get stuck in it. Sometimes I wonder if there is spiritual gain or value in being depressed - perhaps it is unwise to try to squash them out all the time. Maybe there's a purpose of being in the depressed "place" for a while.

In some ways, depression is like a bad weather system. Sometimes you can continue to do your daily life despite the weather. Other times you change your plans a little because of the weather. Still other times, you hunker down and wait it out.

Depression actually motivates change for me. When I get depressed, I don't like the feeling, so I try to figure out what causes it and how I can change to avoid it. Sometimes I find an answer, sometimes I don't.

Conclusion

When I was younger, I didn't have the tools to deal with depression and anxiety. Unfortunately, no one taught me how to deal with it - I was "bad" if I felt this way, and I needed to deny it, ignore it, or just get over it. The result was not pretty. When I was younger I was bulimic and I episodes of manic depression. And at some points I was seriously suicidal.

Now that I am older, I don't have those extremes so much any more. Thank God for that!!! However, as I stated before, I deal with it almost every day of my life. I don't like it very much. This is the hand I have been dealt. There are plenty of fantastic things about me, too, and over time, I have come to accept the entire package.

Quilt plan for 2008

I completed Adia's quilt and mailed it this week for her Christmas gift. I am pleased with how it turned out. Of course there are things I would have changed had I known how it would turn out. The main thing I am disappointed with is how the colors come together. They look good, but there is not a lot of contrast, except for the yellow. The yellow pops out too much, in my opinion. The binding didn't come out perfect, either. I used by 1/4 inch foot on the machine to sew it on and it resulted in a 1/4 inch seam. Not surprising....except that I'd used a binding strip that was wider than needed. The binding was uneven front to back.

I'm so picky.

I think Adia will like it.

Now, what to quilt for next year??? I have three ideas so far.

1. Dexter's quilt

   I would like to make a quilt for my nephew Dexter. He will be 6 next year, the same age as Adia is this year. I haven't settled on a pattern yet. I have in mind making a denim quilt. Everyone who has ever had one (that I know) has loved their denim quilt. It's a boy/guy thing.



2. Baby Quilt

   I have some friends that are trying to get pregnant. Assuming they succeed (I sure hope they do), I would like to present them with a quilt. It's such a nice and unique gift. And they're easy to finish, compared to a twin size quilt!



3. My Quilt

   I started a pattern this year for a quilt for our bed. It is a log cabin block set in the star configuration, with sashing between. I saw the pattern in an American Patchwork and Quilting magazine several years ago and saved the pattern. It takes 80 blocks to make the queen size. I have 20 so far. I'm making it in red white and blue. Those colors imply that it is patriotic, and to some extent it is. It's not corny though.

January and February is a time of productive sewing for me. I hope I will get a lot done!

Other projects

I have been reading a lot lately about couture sewing and I have some projects in mind to make some clothes for me. I hope I have time to work on those projects. My interests are diverse. First of all, I am interested in sewing knits. I purchased some soft cotton jersey when I went to NYC in September and I would like to play with that. I have 3 yards. I might be able to get a dress out of it. I have patterns for knit tops and some exercise wear.

A recent Threads magazine had instructions for building a pattern from a favorite pair of pants. I would like to try this. I am ridiculously picky when it comes to pants and how they fit. When I find a pair I like, I wear them to threads. I have two such pair right now. It would be fun to try to make a duplicate.

I also have a pattern for a new tote bag. I would like to make a new tote for my supplies for work. I found some cute "nursing" pattern fabric last year and I would love to use it for such a tote.

Finally, I want to make some more scrubs. I have some fabric, and I modified a pattern to fit me nicely. I like the outcome. I would love to try some embellishment techniques on scrub tops. I have in mind some "Navaho patchwork" on pockets.

I feel so free now that Adia's quilt is done!!! Creativity flies!

How and Why I Became a Nurse: Part 3

Paradigm Shift

I was tired of being jerked around. I was tired of working on software projects that ultimately got thrown away. I wasn't doing anything for anyone. I wasn't productive.

Finally it came to me. I needed to work for *me*. By this I mean, work at something that nurtured and nourished my soul. If I wanted validation from people I worked with or from the world at large, I wasn't going to get it. I needed a worthwhile job with intrinsic value.

But what should I do???

I tried software for a non-profit and the industry was not compatible with me. At 34-35, I didn't think I had the "chops" to compete in the global software market anymore. Specifically, if I was supposed to compete with 19 year old wunderkinds with no obligations and no life outside of work, who could stay up all night coding for their jollies, I was going to lose. I wanted a life. I didn't want to give that much of me to a job that I couldn't see as giving me back much. The kind of work I wanted to do in the software industry is just not valued by the industry - good, realistic project management or superior user interface design and implementation.

Heh. That reminds me. A friend of mine used to call software programming as mental masturbation.

Oooh, look how clever I am, that feels gooooooood.

Back to the subject. What should I do?

I went to a Christian counselor for job counseling. I had a vague feeling that I should do God's work. All the literature says to rely on God and trust. Give your life over to God. I prayed and prayed.

Eventually, through work with the counselor and through prayer, and after taking every career aptitude test I could find, I was guided towards nursing. I spoke with nurses about their jobs. I found a woman who was a nurse who was getting into software work, related to clinical trials. I also thought about the future - I am intrigued by the idea of missionary work. Nursing skills are a lot more useful in a developing country than software development!

Before I decided to go into nursing, I struggled with the idea of becoming a nurse. Nursing wasn't a job for the smart people, and it was a girl job. I had been raised that I was as smart as a boy and I had to prove it. I had been in a male dominated industry all my adult life. Much of my identity was tied up in proving how smart I was. Part of my insecurity was the fear that I wasn't as smart as I thought I was. Becoming a nurse would remove my professional identity as a software developer. Undeniably a profession that is assumed to be smart! I wasn't thrilled with the idea of being low-man on the totem pole again and not being an expert in my professional life.

I struggled for a long time. But the allure of a happy life and the erosion of my happiness in my current work made me come face my issues. I had been depressed before. If I stayed on the current path, I was going there again.

In Oprah magazine, I read an article about how when we are faced with a dilemma where there is no solution, we must shift the paradigm and transcend the problem. That is what I did. I decided to work for my own satisfaction, to work to embody my values and my faith, and to use my life for God's purpose.

Screw the worldly values.

I had one family member ask me was I was going to *do* after I got my nursing degree, like, get a masters, teach, do research. My reply was that I thought the world needed some really smart nurses.

My mom said that I'd have to empty bedpans. Yeah. So? We all poop.

I still get pangs of ambition - that desire to show how smart I am. I struggle to stay humble. I have, in fact, transcended to another plane of professional satisfaction. I am happy with my work and I have mostly shed my old identity.

Don't get me wrong! I'm still a mere human, and life is not perfect. But living a life consistent with your values is so much better.

How and Why I Became a Nurse: Part 2

Part 2: Transition

After I left Terrific Company, I started a new job with a non-profit that primarily did government research. Lots of social science research and they were looking to get into clinical trials work, primarily epidemiology. I had been involved with the business of clinical trials before (precisely, the software that did the analysis for clinical trials). I had a friend who had gone to this company and we'd been talking. I had other friends at the company, too. I thought it would be great. This company ("Research Company") had a mission that inspired me.

Too bad I can't remember it now. It had something to do about helping people and improving the human condition.

It was a disaster. Research Company had no work for me. When they did have a little bit of work, I was supposed to do a lot of it "on my own time" because that's one way they kept the cost of their contracts down. They tossed me new-grad level computer programming work, when I expected to do million-dollar project management. When they did give me a project to manage, they hated my realistic project plan. I was stressed out because I had no direction with intense pressure to bring in money for the company. I remember asking at one point, "Am I missing something? Am I supposed to be finding my own work within the company, and I don't know it?" My friends at the company were too busy with their jobs to mentor me or help me find my way.

One of my friends I had in the company was a man I knew from church. He was just a dude in nice suits to me, but he was actually a "C" level executive with the company. I had his ear. During the whole time, though, I think he was just trying to get me into the sack. He probably helped me get the job. I did realize at the time that he wanted to bed me; I planned to use that position for all it was worth. Without actually having sex...I was married and had no inclination to ruin my marriage for this Bozo.

I'm married to a really good guy.

Also in retrospect, during these months, I was very, very angry. Professionally, I felt so betrayed by Terrific Company and the software industry. I felt so powerful and clever and smart. It burned me up that no one could recognize what a great employee I was. Why didn't anyone want to keep me at this company? Why didn't I get attention and support??? I know I talked way too much and said way too many things to too many people that probably hurt my image and my career.

I had also grown accustomed to the "entrepreneurial" model for business - small, agile, energetic, fast. A government research company is the exact opposite of all of these qualities - despite the lip service they gave to these trendy ideas (in 2002).

I needed to be selfish for a while, and not ally myself with any company. I was not ready to commit again. I went solo. I left 7 months after starting and went into independent contracting. Guess who my first contract was with?

Yep. Terrific Company.

It was a totally different group (in fact, with people I knew back when I first started at Terrific Company 10 years earlier). It was a totally different area - document management. I contracted with them for about a 14 months. During this time, I did the work that eventually became my (our) patent.

Ironically, as a contractor I made more money than when I worked for Terrific Company, and I had my private office back.

Also during this time, the seeds of the nursing career were planted and began to grow.

Coming next: Part 3: Paradigm Shift

No Longer a Secret

I told my husband about my blog. I have wanted to for a while, but as soon as I did, I regretted it. I guess I really want an online diary where I can confess my deepest thoughts and my fleeting whims. I have made the blog private now.

I didn't mind the idea of strangers reading about me, but people I know? That would cause repercussions.

I don't have anyone I can talk frankly with! In the past it has been friends and boyfriends (at my peril), then therapists. I am wise enough now not to be so open with my friends and spouse. I don't have a therapist now.

The Internet has the answer to all of life's problems, right? It can solve mine, too.

I shall continue soon.

How and Why I became a Nurse: Part 1

Part 1: The Fall

When I was about 37, I began to feel like my career was not going anywhere. I was a software developer. I thought I was reasonably talented at it - there was never a problem I couldn't solve in code, one way or another. I especially enjoyed user interface design, software design, project management, and working with the clients/users directly. I have a bachelors and masters degree in computer science.

I'm smart. There I've said it.

What happened that soured me on the industry is this. I worked for a terrific software company. In the frenzy of the late 90s and early 00's, the division I worked for was spun off as a subsidiary owned by the original company. This was in 2000, and I was 34-35. We were given a week to decide if we wanted to go with the new company (and stay with our current work group and products), or we had that same week to find another job in the company. A week! What the hell?? Most of us went. Golly, this was exciting.

We were given seed money and we were kicked off the main company's campus. This is significant because the main campus has a load of perks - a gym, day-care, subsidized cafeterias, etc. Then, we sacrificed our Christmas bonuses to reinvest the money in the company. We gave up our lovely private offices with doors and windows, to have cubicles. We worked our asses off to get our first product ready. We did. On time, even. We had buyers in the pipeline. We kept expenses down, and our seed money lasted 50% longer than expected.

Then the owner of the original terrific software company (I"ll call it Terrific Company) decided we weren't making money. (Duh. We were a start-up.) So he decided he'd just cut us loose, and if we wanted we could re apply for our old jobs. There weren't as many old jobs available as there were people - funny coincidence, don't you think? There was also the opportunity to take a buy-out. This is what I did. Those of us with tenure at the company had a pretty sweet pay-out - if I remember correctly it was 2 weeks of pay for every year of service. For me, that was almost 4.5 months of salary. The end result was that several experienced workers left, and the new hires stayed. And those with families and health problems. See, the benefits at Terrific Company are unbelievably generous.

Notice I didn't say the good people stayed and the bad people left.

This sequence of events broke my heart. What it taught me was that as hard as I would work, I was at the whim of a company's management. And as much as I liked Terrific Company, it was run by a benevolent dictator (with dicey morals, by the way...I didn't like hearing about all his affairs with female employees. Sheesh.) Additionally, it didn't look like I'd ever be management. I had been on the management track in the subsidiary; in fact, I was a manager for a whole 3 months in the subsidiary. In the big company, I was to be a plain old software developer again.

In the chaos of trying to find a new place in Terrific Company, I contacted some people I knew in the usability group and asked if they would hire me. I loved doing that work, and I really believed in it. I negotiated. I bargained. But, they couldn't get a position for me. That was the end, and that's when I decided I was done with Terrific Company.

My buy out money financed my education in nursing. It took a while to get there, though. Watch for the next post.

A Post to Start December

Work

Holy crap. I placed several more IVs recently on Thursday, Friday and today. What is going on? Is it the end of days?

Oh, as if I would be so significant.

Actually, this morning, I had a small epiphany about how to visualize IVs. I think that maybe I wasn't advancing the needle enough and I'd tear up the side of the vein trying to thread the catheter. I am trying a subtle change in my technique with this in mind. I'd love to claim success based on this epiphany, but in today's case, I went for an antecubital vein. In most people it's a big honkin' vein, and usually an easy one to hit.

However I got it, I got it.

Church

Last night I went to an event at my church. I am not exceedingly involved in my church, and I usually just go to worship and participate in worship. I sing with the praise team - the group that leads the hymns during the contemporary service.

The event last night was even more unlikely for me to attend. It was a concert of children and youth performing the carols and Christmas music they have prepared. It consisted of choirs and handbell groups, primarily grouped by ages. Since I don't have a child and I'm not involved in youth or children's ministry, it is unusual that I would go. I went for two reasons. First, we had bid on some items at the youth fundraiser (a silent auction) and I thought we were going to get them. You had to be there to pick them up. Second, I thought the event was more of a choir and congregation singing event. Not just kids. I was apprehensive once I realized what it was. But I had to stay to pick up my auction item(s)!

A few thoughts on this.

Here in the midwest, it seems that everyone is musical. The choirs are packed, with girls *and* boys. And they actually can sing! The church has enough members with diversity in musical talents that we have an orchestra. People are interested in playing handbells. They think it's fun.

Maybe I've been a midwesterner all my life, unrealized. Not only does everyone do music, they let everyone do music. It isn't just the best of the best, and if you aren't the best, then there's nothing for you to do. I think that is unbelievably cool. Whenever I tell someone I play clarinet or sing, they usually respond that they play this or that instrument, or they sing in a choir, or they used to be in a band and they cut a few records "back in the day."

I previously lived in the southeast (North Carolina). There just weren't as many opportunities to play because music wasn't very cool, and it seems like all the gigs were the same clique of people. Like, there was one oboe player in the Raleigh Durham area and he got all the jobs. Prior to that I lived in Rochester, NY. Home of Eastman School of Music. I didn't have a prayer of playing or singing. Prior to that I lived in Northern NJ. The competition for opportunities to play was all the musicians in New York City.

Back to the story of church....

Overall I had a good time. The performances were better than I expected. I won some tasty sweet-salty snack mix at the silent auction (and paid too much for it, but hey, it supports the kids' mission trip). We got to see a side of the church we rarely ever see.

My husband actually came to this event with me. That's another remarkable thing. He doesn't like these kinds of things very much. He's a strong introvert and is uncomfortable in a crowd of people he doesn't know. He doesn't like musical performances like this - kids' music can be rather trite, you know. He was kind of negative about it. I don't think he regretted going, but I don't think he enjoyed it very much.

Quilting

I worked a lot on my quilt this weekend. Lousy weather on Saturday helped - I stayed in all day. I pretty much finished the quilt! YAY! The binding is sewn on but it needs to be tacked down. Tomorrow is Quilt Guild day. It is done enough to show at the meeting! I met my goal!

An amazing event

I placed two IVs successfully today. Holy crap. That will probably rule out any successful IV's through the first quarter of 2008. I must not get my hopes or expectations too high.

I have obsessed a lot on work recently. Today I would like to write about quilting.

I spent a good portion of my Thanksgiving holiday working on a quilt I am making for my niece. I am reasonably pleased with how it is turning out. It is a large twin size quilt made by a pattern called "Baby Steps" from the book "P.S. I Love You 3." This book is one of my favorites - so many pretty designs.

The piecing consists of squares and rectangles arranged in a straight set. The positioning of the partial-blocks and blocks give the top a random look, although on closer look, it is not really random. I used similar colors to those used in the book: fuschia, aqua, purple, green, and yellow. I used tonal fabrics. The fuschia and yellow have patterns, while the other colors have a mottled, "marbled" texture.

The fabric choices turned out alright - it is sufficiently bright to enchant a 6 year old girl. You never know for sure how it's going to look in the end, when you are picking out the fabrics. Most of the colors are of similar values - medium-dark - but the yellow is quite bright. It really stands out. I would choose a little more contrast in the values of the colors if I were to do it again so that the yellow pieces don't jump out so much.

This weekend I finished quilting the interior of the quilt. It took about 20 hours. I quilted a lines with a floral pattern evenly spaced across the top (but not associated with the piecing). Then I filled in the background with a swirled pattern inspried by the pattern in the fuschia fabric. This was my first major piece of quilting doing free motion machine quilting. I am fairly pleased with how it turned out. While my stitches are not very consistent in size, the patterns are generally smooth and attractive. I used variagated thread, and I'm not sure I'll do that again. I don't really like the effect; some places the light thread screams out against a dark background, while other places it blends in. As I said, it should be sufficient to delight a little girl and withstand being jumped on, wrapped up, thown on the floor, and washed repeatedly. Maybe, if I'm really lucky, it will become a beloved blankie.

The quilt feels just wonderful. To me, the most captivating aspect of quilting is how the fabric takes on texture and substance when quilted. Sometimes there's a pattern you can see, sometimes it's all in the feel. The completed center is heavy and pliable with a body-hugging drape. You wouldn't think something made of flat, smooth cotton can be so cuddly, but quilting does it. After it's quilted, I brush my hand lightly over the lumpy surface and coo in hushed tones

I have to finish quilting the border this weekend. I want to show it at my quilt guild on Tuesday before I give it to my niece for Christmas.

Free motion quilting takes practice. It is possible to achieve awesome results on a home machine; I have seen some amazing things done on a small machine, not a long-arm quilter. Practice is the key. I can see improvement in my skills from the start to the finish of my work on this piece. I want to be good at it, so I keep on trying.

And now, my philosophical finale: When you live long enough, you have time for different lives. I am 42 and I have been a musician, a country-western dancer, a bowler, a registered nurse, a weight-lifter, a sewer, a singer, a computer programmer, a researcher, a salesperson, a Christian, a pastry "chef," a vegetarian, a patient, an environmentalist. (Oh, not all of these were professional!!!) I can speak a little French, Spanish, German, and even a little Japanese. I know how to finger-spell and I know a little sign language.

I look back over the years, and some of these things seem so foreign, so long ago. Like I was a different person. But no. that was, in fact, me. Very curious. Who am I to strive to be a master quilter? Is not a musician, bowler, researcher enough??

No.

Success

I actually placed an IV successfully yesterday on the job. I was elated!

Realistically, this probably means I won't hit another IV until 2008. There is always hope.

The workday, part 5: Editorial

Overall, I really like my job. The previous posts may suggest otherwise, and accordingly I am starting with the good aspects of my work.

Why my Job is Great

1. I work 3 days a week.


2. I get to help people and I get to interact with my patients and their families.


3. My patients are generally nice people who are in the hospital to fix a problem, not put there by bad luck or circumstance.


4. My coworkers are good to work with. I like them and I even socialize with a few of them outside of work.


5. I have a good manager. My charge nurses are also excellent.


6. I work only part of a Saturday every 6 weeks or so, and never on Sundays.


7. I know what I'm doing.


8. About once every two weeks, I get to come home early


9. There are downtimes. I actually have time to pee and to eat lunch (most days).


10. I get to know the doctors and their teams. I generally like all of them, too.


11. There's a little bit of excitement every now and then.


12. Every once in a while I really help someone.


13. My employer offers good benefits.


14. My pay is decent.I could definitely live on it.

Challenges of my Job

Most of the issues I have with my job is the milieu of being a nurse. They are not specific to my unit - in fact, most hospital nursing has similar problems.

1. Work flow is unpredictable. I would like to partition my work out more evenly through the day, but experience has shown that this is very risky.


2. Despite our greatest effots, things all seem to happen at the same time and everything needs to be done right now.


3. Nurses are frequently caught in the middle between patient safety and demads of the job. Of course patient safety comes first, but in these situations, the cost is usually the nurse.


4. Sometimes people think you're not too bright if you're a nurse.


5. Nursing wants to be respected as a profession, but it continually is treated like (and acts like) a trade. This is partially the fault of the structure in which nurses work and partially the fault of nurses themselves. I don't know what the right solution is.


6. Nurses are expected to know everything and be good at everything.


7. Nurses are expected to read doctors' minds.....correctly.


8. Nurses are the front line of defense against mistakes. If the pharmacy makes a mistake, the nurse is supposed to catch it. If the doctor makes a mistake, the nurse is supposed to catch it. If the nurse doesn't catch it, the mistake is her fault.

My Personal Challenges

I have been dying to confess this, but I am afraid of the repercussions if I talk about it too much. The issue is this: I am not good at placing IVs. I have tried and tried. I have gotten feedback. I have spent one of my days off following the hospital's IV team to learn pointers. I cannot do it. I can hit the vein, but for one reason or another, I can't thread the catheter in the vein. I have been struggling with this for over a year. When I ask for feedback and have people watch me, sure enough, they can't find an obvious reason for my lack of success.

This is a big deal because we start IVs on all of our preps. I am confronted by it every single day.

It is wearing on my psyche. Several times, I have wept at work (briefly, in private) when I fail. I am frustrated and I hate hurting the patient with no gain in the end. It is beginning to wear me down...in fact, if we weren't short staffed on my unit, I might fear for my job. This is one reason why I don't seek more help at work.

In my defense, many, many of our patients are hard sticks (that is, difficult to place IV's in). They're dehydrated little old ladies with no veins - I'm generalizing, of course.

I don't know what God is trying to teach me with this challange. There has never been anything that I haven't been able to conquer (or at least, improve), with hard work, education, and practice. This seems not to be the case! I can only assume that God is trying to teach me something and I stubbornly won't learn it. Too bad I don't know what that something is....and because I believe God asked me to be a nurse, this is particularly troubling.

I fear that this challenge could be what does me in, in this job...that is, it will wear on me too much, and I'll move on to something that doesn't humiliate me every day.

Another challenge is the situation of a predominantly female work environment. Weird things happen when it's women only - cattiness, lack of understanding, too much food. I used to work in a male-dominated field, and it was so different. Not really better, just different....and since I grew up in that environment, I find the female world a little foreign.

These are my thoughts on work for now. I expect I'll have more in the future. On to other things in my next posts.

The workday, part 4: Afternoon, Shift Change, and Home

The afternoon can go in two different directions. The majority of time it's boring. Patients ride out their 6 hours of bedrest and we monitor them. After the first 2 hours, we are only doing vital signs every hour. Patients are sitting up 30 degrees, and they've eaten. If they were going to have a complication, they've mostly had it already. Now they get bored. Now the shenanigans can being.

Things I've seen

The patient is on bedrest. The theme is to keep the groin area immobile and straight, and don't increase interabdominal pressure (that is, don't pull up with the abdominal muscles). Once there was a resident who told the patient to lean forward so she can listen to the patient's lungs. The patient thought that she shouldn't do it, but naturally, she obeyed the resident. Surely the resident knew what she was doing, right?

Ak! No!

Fortunately for this patient, she did not rebleed. Stupid resident.

I've seen people decide they need to roll over on their sides and curl up for a nap. No.

I've seen people in tobacco and alcohol withdrawal who can't lie still. Earlier in the day they swear it's not a problem, and they won't need a nicotine patch. Yeah.

No one likes to use a urinal or bedpan, but there's no getting up to the bathroom while on bedrest. I've seen a few patients rebleed after trying to use the urinal (men). They don't ask for help, and then raise up their heads to see what their doing, and pop! Hey, nurse? There's blood on my hands. (yeh, and everywhere else.)

The women aren't so bad, but they can't attempt to use the bedpan by themselves. We place them on the bedpan. Sometimes they pee all over the bed. This doesn't really bother me, though, because using a bedpan is hard and sometimes it's not positioned well, and women have lots of flesh in the way.

I try really hard not to embarrass people about this issue. It *IS* embarrassing, and we force these folks to be in a situation where they cannot take care of themselves. I just wish people would ask for assistance rather than try, if they aren't sure. I don't want to force myself on them, either.

It does bother me a little when a patient has to poop during bedrest.

The Easy Afternoon

On an easy afternoon, I can finish up my paper work. If that's all done, then I can goof off some, like check my home email, surf the net, do ancillary tasks like chart audits, peer reviews, restock supplies, etc. I cannot count on this time being available though; as a result, more often than not, I don't have any paperwork to do - I rushed through it earlier! I really wish I could partition my work out throughout the day so that I can do a quality job and not feel so hurried. It's unwise to do so, - getting the paperwork done, even if it's hurried and sloppy is better than not getting it done at all.

The late afternoon is when the early cases get off bedrest. Some people go home. In this case we complete their discharge paperwork, discharge teaching, and send them on their way.

Wait. Did you reach the logical conclusion? Some people come in and leave in the same day. We've done an entire admission and discharge on these people. This is why I use the term "shitload" for the amount of paperwork. I have created an entire chart full of paper for them. Some people come and go in as short as 3-4 hours!!!!!! That's one reason why you can't put off your paperwork. By the time you realize the patient is going done, you should have had it all done already.

The other reason you can't put off paperwork is that an easy afternoon can turn into a difficult afternoon without any notice.

The Difficult Afternoon

An afternoon is difficult when the labs are working late into the afternoon and/or everyone, it seems, gets complications. Other factors include: lots of patients, high-maintenance patients or family members, and a number of patients getting changed to inpatient status and moved off the unit.

We also have fewer staff in the afternoon - several nurses and cardio techs do not work the 12 hour shifts and leave at 1630. Sometimes we get stuck waiting on only one cardio tech who remains through the end of shift to do sheath pulls because they pile up and back up. It sucks for the cardio tech because they go from holding pressure for 20 minutes straight to another, to another. It's physically difficult.

Sometimes management pressures us to get patients off the unit before shift change - usually it's a staffing issue. A patient has been changed to inpatient status, and we need to move them to an inpatient unit, because we don't have enough nurses on night shift to allow that patient to stay in our unit.

When I am this rushed, I am most vulnerable to errors. Thanks to my guardian angel, I have not made many errors, and those I have made have not been dangerous for the patients. I have just pissed off my team members.

Example

On one recent afternoon, I was trying to get a patient's sheath pulled and moved upstairs before night shift. The patient had an ACT of 186 when he returned, and 2 hours had passed waiting for a cardiotech to do the sheath pull. It looks like the stars were aligning to have this all happen; the cardiotech became available, and if we starte right away, I'd be able to do the sheath pull, give 1 hour recovery, then get him upstairs. Bam, we started the line pull. I had not rechecked the ACT before we pulled because on average, a patient goes down 50 seconds every hour after the stop of the blood thinner. This means that even if the patient had terrible kidney function (which he did not) he should have been within range.

So when the 20 minutes of pressure was done, the patient was still bleeding!!!! Why? This made no sense???!!!

Well, it turns out, the patient's ACT was over 300 upon return to the unit. I was given an erroneous report. Due to other stuff that happened that afternoon, I had received report second hand, and somewhere between the cath lab nurse and the nurse that took report and me, the number had changed.

The patient was not harmed, but we had to hold about 30 minutes of pressure. It slowed everyone down. I felt bad...usually I'm very conservative with having numbers to back up my clinical decisions.

Indeed, I was rushing. I learned from this experience.

Shift Change

At shift change we give report to the night nurse. Hopefully all of the paperwork has been done for the patient staying over night. In most cases it is. I hate leaving a "mess" for the night nurse.

Mostly our team is pretty good about messes. They usually know that if the paperwork isn't completely done, then there is a good reason for it (because in the vast majority of instances, the paperwork is done to completion!). Every once in a while someone has an attitude about it. I hate that, but I get the hell over it.

Our night shift nurses are good. They come in on time, get report, and take right over. No one has called me after shift to ask questions. (That happened once on my previous job - that stressed me out all night.)

Going Home

When I have given all of my reports, I pick up my stuff from my work station (if any) and log off the computer. I take off my Vocera, check for medications in my pockets, and leave the unit. First I go to the breakroom to pick up my lunch bag, sections of the paper I would like to keep, or any other things I'd stashed in my mailbox cubby. I clock out, then go in the locker room to un-gear for the the day. I empty my pockets. I hope I don't find any medications in my pockets becuase then I have to go back on the unit and return them. Don't want to be walking off the unit with a pocket full of Valium or Morphine! That's a quick way to get fired.

I bundle up if it's cold out (like yesterday - sheesh, 32 degrees!!!) and walk to the car. It takes about 7 minutes. Then drive home. I listen to NPR on the ride home. Usually I'm hear the last half of "The World." That's fun - I get to hear the "Geo-Quiz." Mostly I'm driving home between 1920-2000. Sometimes earlier, sometimes later.

At Home

When I come home, I want to be cared for. I want my dinner ready (or in the works) and I want to sit. I usually don't get this luxury. Sometimes I do, and I love it when it happens.

I go upstairs and change clothes. If I was mindful at work and drank my water, I usually have to pee (this is important, because I just don't drink when I'm working and that's not healthy). If I'm motivated, I'll wash my face for bed and take off my eye makeup before coming back downstairs. Then I eat. On the days I work, my husband is responsible for making meals, and about 90% of the time a meal is in the near future. My husband is not the most inspired cook. On a good day, I get hamburger helper, chicken helper, or a Zatarains mix. On an average day, I get spaghetti with sauce, sometimes with a can of mushrooms mixed in or some ground burger (fake beef) mixed in. Sometimes it's leftovers. I almost never get vegetables or sides with these dishes (such things are unnecessary, I suppose).

I don't complain about the food. After 10 years of marriage I have learned that this kind of griping is pointless.

However, I still hope. It feels so nice to come home to a fresh meal. Occasionally I am surprised! Occasionally there is the thrill of fresh take-out!

Dinner and After

We eat dinner sitting at either end of the sofa watching Tivo of all the shows he likes. I enjoy them too, but I can live without them. Apparently, my sitting next to him quietly is very nurturing to him. If I want to talk, or if I want to sit at the kitchen table, he seems out of sorts.

We watch Jeopardy, The Daily Show (up until the writers strike), Grey's Anatomy, Pushing Daisies, Private Practice, Heroes (ooh, we actually watch THAT one live...), Reaper, Torchwood, or Graham Norton.

I ask him how his day is, and he says, "Not bad," or "I had a day." What did you do today? "Work." Anything interesting? "No." Oh.

He may ask how my day was. I'll say "Excellent." This is because if I say anything negative about my day, in his mind, I don't like my job and I'll be looking for another soon. This is not true: in fact, I like my job very much (see more about this in the next post). But, like many men, situations are either black or white. So, I'll whitewash to avoid accusations. I try not to talk too much about my day, either. Most of my issues are either mundane or disgusting. There are HIPAA issues to be considered. Or I get sucked into complaining about something....danger, danger!

...now you know why I am writing this series.

I tend to eat too much when I get off work. I am hungry, since I don't get a dinner break at work (I get a lunch break most days). But I crave the comforting feelings I get from food after a hard day. Since dinner isn't ready when I get home, I eat something that is easily grabbable and keep on eating until dinner. This is not good.

I try to do a few chores before bed, and often I'll work a few rows on a knitting project. I give attention to the pets. If I'm lucky, I'll remember to empty out my lunch bag from the workday (to get it ready for tomorrow), and I'll remember to plug in my cell phone. Sometimes, if the day was really busy, I curl up on the couch and doze off.

At 2130, I'm off to bed.

Coming next time: The workday: An Editorial.

The workday, part 3: The Sheath Pull

One of the most common procedures we do on a patient is a "sheath pull." Sheath pull is our slang term for the process of removing the tubing device (sheath or "line") from a femoral artery or vein and holding manual pressure on the puncture site until it stops bleeding. Many patients come back to the unit with the tubing still in place - sometimes several lines. There is usually only one arterial line. Patients who have cardiac catheterizations, ablations, or occasionally pacemaker implants may come back with one or more sheaths.

The criteria for a sheath pull is whether the patient's blood can hold a clot sufficiently. This is determined by a brief lab test called the ACT, or Activated Clotting Time. If the ACT is 170 seconds or less, it is safe to remove a sheath. Anything greater, the patient's blood is too thin. During the procedure the doctor may infuse a blood thinner, such as Heparin. This medication thins the blood and raises the ACT. Therefore, if the patient comes back and has received heparin, we must test the blood for its ACT. We have a device that does this test. It's helpful we can do this test ourselves.

An alternative to heparin which the doctor may choose is Angiomax. This is a glycoprotein III inhibitor (a.k.a. blood thinner of a different kind) and the body processes it at a much more predictable rate. We wait 2 hours after the Angiomax infusion was discontinued, then it is safe to pull the sheath.

Sometimes the doctor uses no blood thinners, and we can remove the sheath immediately. Sometimes the doctor uses a closure device such as Angioseal or Starclose. Rarely a patient goes directly to surgery or has complication that sends him/her to the ICU. Even more rare, the patient dies. Since I've been working on the unit, this has happened only once.

It's interesting. The patients and their families expect us to know exactly how the day will go for the patient, like when they can eat, go to the bathroom, or go home. Honestly, we don't know a whole lot until the patient comes back from procedure and we know what medications the doctor used and whether a stent was placed. They understand once we explain it.

The Removal Process

Obviously, we only remove a sheath when the patient has one - this procedure is not done for Angioseal and Starclose patients. We love when they use a closure device.

Removing a sheath is a two-person task. One is the cardiotech, who is specifically trained in sheath removal. The other is the nurse who monitors the patient during the process. The cardiotech removes the tubing and holds pressure. The nurse is there because once the sheath is removed the cardiotech MUST NOT UNDER ANY CIRCUMSTANCES let up on the pressure. Otherwise the patient will bleed to death.

The Nurse's Role

So, the nurse is there to record vital signs (which are taken every 5 minutes), administer medications, or address any complications. The medications we typically use are morphine for pain and diazepam (valium) for anxiety. Sometimes we use fentanyl if a patient is allergic to morphine.

We watch for a few types of complications. The most common is a "vagal" which means the process of holding pressure on the groin stimulates the vagal nerve, which in turn lowers the blood pressure and heart rate. The patient may feel nauseous and throw up. The patient may break out in a cold sweat and feel light headed. We have specific protocols for how to address these things. Rarely a patient will pass out.

Because of the possibility of throwing up, the patient is not allowed to eat up until after the manual pressure procedure is completed. Patients hate that, but really, it's better than inhaling your barf and suffocating.

I have observed that if you give a patient both the Morphine and the Diazepam, they tend to vagal more frequently. These meds are depressants, anyway. I am very conservative in my administration of these medications for this reason. We have some flexibility in how much we can administer, so I always start slowly then increase. I can't un-administer!

Other complications include pain and internal bleeding.

For the entire sheath removal process, the nurse must be in the room with the patient. This means I can't care for my other patients. Most often, we help each other care for their other patients while someone's doing a sheath pull; sometimes, a nurse will do the sheath pull for another nurse. But the way things most frequently work out, you are doing a sheath pull when another of your patient arrives on the unit (a prep!), goes to procedure (give report to the lab nurse?), returns from procedure (get report from the lab nurse?), or crashes in one way or another.

You just gotta lean on the team, there's no getting around it. You also are expected to step in when another nurse is so occupied.

Holding Pressure

The tubing is removed and the pressure begins. Initially, it takes a pretty good amount of pressure and it's uncomfortable. For some people it's quite painful. I think it has to do with the patient's tolerance for pain, the location of the puncture and the patient's anatomy - how close the nerves are to the puncture, etc. Who knows this, though?

The pressure goes on for at least 20 minutes for an arterial line, at least 10 minutes for a venous line. If all goes well (as in most cases), the bleeding is stopped and the countdown begins for when the patient can eat and get up. Sometimes it takes longer for the bleeding to stop. If the ACT is too high, the bleeding won't stop any time soon...hence the reason we check ACT.

Holding pressure is a physically demanding task. It is a skill, if it is to be done well. We usually have 2 cardio techs on the unit for this task and they alternate doing the sheath pulls. However, frequently we have a bunch of sheath pulls all at the same time.

Nurses are not trained to do a sheath pull on our unit. Legally, we can be, and I would like to be so trained. I think we don't get the training for managerial reasons; that is, we are more valuable to the unit in our other role. I agree, but it would be nice to have a few back up people trained for those crazy days when we have a bazillion sheaths and only one cardiotech. When that happens, the patients must wait to get their sheaths out, and waiting is a real drag. It lengthens their bedrest period and delays everything from moving along.

If the patient tolerates the procedure well, I usually use the time to catch up on paperwork - generating the shitload of documentation I have mentioned in a previous post. It's a good time to complete the patient profile.

After Hemostatis

Hemostatis is the official term for "the patient has stopped bleeding." This is the moment when we start the countdown for sitting up, eating, and getting off bedrest. The patient must remain straight with legs immobile for the next hour. Even though the puncture is not bleeding, it is delicate. If the patient moves too much or the fragile clot lets go, the patient will bleed internally. They will usually feel it ("Hey, this puncture kind of hurts..., oh, now it really hurts") and a big bulge appears at the puncture (a hematoma). I haven't had one squirt all over the room, but that's possible too.

In this case, we hold more pressure (and it really hurts this time) for another 20 minutes or more, try to work out the blood of the hematoma, and start the countdown all over again.

After one hour post hemostatis, the patient may have the bed raised up 30 degrees and may eat. Bedrest continues and the leg(s) with the punctures must remain still for 5 hours (arterial line) or 3 hours (venous line).

This is the hardest part of the day. Most patients feel fine and want to get up to pee, or whatever. They get bored, especially after they've had some food and there's 4 hours left with nothing to do but watch daytime TV. It is too risky to get up - if they bleed again, then we start the countdown all over again.

Vital signs and Assessment

After hemostatis, we monitor vital signs every 15 minutes for the first hour, then every 30 minutes for 1 hours, then every hour for 4 hours, then every 2 hours for 4 hours, then back to our unit standard of every 4 hours. We also assess the patient's pulses in the foot of the leg with the puncture, and we check the incision for bleeding. We look at lots of groins and palpate lots of feet.

Thoughts on the Sheath Pull

As I've said before, I think the doctors don't emphasize the duration and physical demands on the patient during the post-procedure time. It can be a long time before the patient can eat - for example, if the patient's ACT does not get into the safe zone for a few hours, no eating. Patients must lie flat on their backs for a long time.

Looking back over the last year of many sheath pulls, I have the following observations:

• Skinny little old people seem to have the most difficulty with the pressure (e.g. vagals) and rebleeds. I've had several little old ladies sit up after six hours of bedrest and have their incisions open up internally. Here we go again with the pressure and bedrest. You get a nasty looking bruise if you rebleed.
  
• Young men are the biggest whiners for pain.
  
• Some old men are terrible whiners, too.
  
• Most people do just fine with the process and complying with the instructions.
  
• Some people are so fat, the nurse must raise the "apron" of fat out of the way so the cardiotech can get his or her hands in the proper position to hold pressure.
  
• Most people, especially old people, have lousy looking feet. Cracked skin, fungal toenails, stinky. Oh, for heaven's sake, take care of your feet, people!!
  

Coming soon: The workday, part 4: Afternoon and the end of the Day.
I have to work tomorrow and the next day, so it's unlikely I'll post until Thursday.

The workday, part 2: late morning

The schedule of when I get patients on the unit is highly variable. I could have new admissions all day long. Sometimes I get patients who are admitted to the hospital already.

Documentation

We do a shitload of documentation on each patient. Our manager has concluded that for safety reasons, we need to do an entire hospital admission process for everyone who comes in. The outpatients, that is - inpatients should already have that done. For every patient we need to:

1. Do the admission process in the computer system which includes:
   
2. Review of all medications they are taking.
   Do you have any idea how many people have no clue what medications they take and when???. Horrifying
   
3. Validate all of their medication sensitivities and allergies.
   
4. Get information on their legal status regarding durable power of attourney, living will, etc. If they have one, I need to find it and get it on the chart if possible.
   
5. Investigate their living situation, and see if there are any dependents
   
6. Get contact information for family and/or friends
   
7. Screen for domestic violence
   
8. Find out if they are in any medical research study and if so, get the contact information
   
9. Assess their ability for self care, such as independent grooming, toileting, etc.
   
10. Investigate their use of tobacco, alcohol, and illegal drugs
    
11. Are there stairs in the house to the essential rooms (bed/bath/laundry/entrance)?
    
12. Evaluate if the patient is at nutritional risk
    
13. Ask the patient if s/he has experienced any major life changes in the last 6 months.
    
14. Finally, get the patient's stated goal for his/her hospital stay.
    This, I think is stupid. Most people say "to get out." Well, duh. Management has decided that this is important, so we do it.
    

In addition to this, I am supposed to validate the medication administration record against the doctor's orders (and against what the patient tells me), I need to run EKG analyses, at least 2 per shift (pre and post procedure), develop a plan for the day, and evaluate the plan of care for the patient.

Then there is the "normal" nursing documentation that is done every shift (or more) on all patients: assessment, nursing note, record intake, output, pain, etc.

It is true, I have most of the day to do all of this for each patient. I try to get it all done as quickly as possible, because who knows what the day holds? I could get really busy with critical patients and not have time to do all of this.

Post Procedure

After a patient comes back from procedure, we assess again, settle the patient back into the room and begin frequent monitoring. Most patients require vital signs every 15 mintues for the first hour, then every 30 minutes, then every hour for 4 hours. This is fun when you have more than one patient on 15 minute vitals. It is even more fun when several patients return from the lab at the same time.

I receive report from the procedural nurse, and follow the protocol as ordered by the doctor for the patient, based on what happened during the procedure.

Cardiac or Peripheral catheterization

A cardiac cath is when thin wires are threaded through the femoral artery or vein up to the heart. They are looking for blockages in the arteries of the heart (mostly..there are a few other things one can do with a cardiac cath). A peripheral cath is when these wires are directed down the legs to look for arterial blockages. If warranted, the doctor can "fix" these blockages with a stent, which is a wire mesh tube used to prop open an artery.

Our most frequent procedure is the cardiac cath. Patients usually come back with tubing (a "sheath") in one or more groin punctures. That is, there's tubing sticking out of their femorial artery. If blood thinners were used during the procedure, we have to wait to remove the tubing until their blood thickens up enough to hold a good clot. The patient has to lie flat on their back until that time, although we can tilt the bed so his head is higher than his feet. They can't eat until we get the tubing out.

Pacemakers

Some patients have a pacemaker placed or the battery on a pacemaker replaced. Occasionally we have an explant or entire replacement of device. These patients come back with an incision in their chest, usually the left side just under the clavicle. They can eat when they're awake, they can sit up in bed, just not move the arm on the affected side.

Ablations

Another procedure we do pretty frequently is an ablation. This procedure uses thin wires to go up to the heart and zap (e.g. burn, electrically) portions of the interior of the right atrium of the heart. Occasionally the left atrium needs to be zapped. These patients come back with multiple sheaths in their groins in the femoral veins, usually bilaterally, and sometimes they have a catheter in their internal jugular on the right side. These patients often have had blood thinners as well, so they must wait flat on their backs as well.

Other variations

Devices are available that seal up the puncture. We use two types: starclose and angioseal. The former is like a little staple. The latter is a plug of collagen that closes up the hole and eventually gets absorbed by the body.

Sometimes pacemaker patients will have a groin sheath as well. During the procedure, if the doctor cannot place the pacemaker leads properly from the incision (via the mammary vein), she will thread catheter wires up through the femoral vein to assist.

Some of the variations for cardiac caths are to measure blood pressures in the hear as it's functioning, measure pressure of blood in the lungs, and assess the functionality of the left ventricle.

Bedrest

Patients are on bedrest post procedure while we are monitoring them frequently. Many patients are still somewhat sedated so they are pretty cooperative. Most of them don't have a lot of pain, again because of the sedation and the local anaesthetic. They come back to us cold, frequently. The cath lab and the EP labs are kept in the lower 60s.

Patients don't like bedrest. Many patients have back problems and it is painful to lie on their backs for hours. Most patients, particularly the younger ones, will repeatedly let me know their backs hurt and that nothing I can do for them helps. No one likes to use a bedpan. At least the men can use a urinal.

Now, we have the annoying variation of the older man with enlarged prostate. Mostly they are embarrassed about it, so they don't say anything until they can't pee and their bladder is extended to the point of pain. Then it's panic time because they are so uncomfortable. But no, they couldn't have said something earlier and we could have placed a catheter. When their bladders are distended with urine, it displaces everything internally, which makes it that much more difficult to place a foley catheter. If I can't do it (and failing at placing a urinary cath hurts!!! Succeeding at it isn't much fun, either.) I have to call the urology doctors and wait for them to come. More pain while we wait.

As you can tell, this process bugs me. Men, get over yourself and let me know, so I can help you. Don't let it come to panic time!!

It's kind of amusing how some people will try to negotiate to get off bedrest early. What am I supposed to do...let them? NO! What if they bleed? People don't realize how high-pressure a femoral artery is and that in a matter of minutes they'd bleed to death if it opens up. I shake my head in disbelief. I guess because they feel OK, they don't realize how vulnerable they are.

They also want to eat. I can give them clear liquids, but nothing else until that sheath is out. The reason for this is that when we do the sheath pull, the vagal nerve may get stimulated, which can cause them to throw up. And if they aspirate the food, then they stop breathing. Not good.

In the end, almost everyone complies. As the bedside nurse, I get to hear about how awful it is. A lot. I wish the doctors would impress upon the patient how long they typically must stay in bed. Patients seem so surprised when I tell them 6 hours of bedrest is required. I think the doctors gloss over it, mutter it under their breath, and patients don't think about what it will be like.

My self care during the Workday

Caring for people is emotionally and physically demanding. Fortunately, we have good teamwork where I work and we help each other out. I try to get my morning "snack" break around 1030 - that's when I usually start feeling kind of light headed and hungry. I like to have a cheese stick, some crackers, a cup of coffee. I like to take lunch around 1330. Of course my self care is variable based on my patient-care demands. Some days I don't get much of a break.

It is so very tempting to eat too much. Like many people, women in particular, I get an emotional lift from having a treat. There is they physical hunger and the emotional need to be cared for given the demands of the job. There isn't much time for anything else, really (a back rub? Leave the unit and breathe fresh air outside? Oh, come on, seriously...)

My little indulgence is to read the newspaper which I bring in from home. I also keep the water at my workstation so I can keep hydrated. I have a terrible habit of not drinking enough. I have gone entire shifts without having to pee. That is not good.

Honestly, though, my unit is not really that bad for self-care. We help each other out, and there are lulls in the chaos when you can get a bite or go pee. When I used to work on a regular inpatient unit, I frequently had to make the choice between getting behind in my work or eating lunch/using the bathroom. I mean, when a patient is in pain or crashing, nobody gives a damn if the nurse is going to crap her pants because she hasn't gone to the bathroom in 6 hours. She should have done that earlier...and no one gives a damn if there wasn't time to do that earlier.

The nurse must assert her own self care in a safe and judicious way.

---

Coming next: The workday, part 3: The sheath pull.

The workday, part 1: Early morning.

I had high hopes of writing to my blog every day, but when I work, I am exhausted at the end of the day. I also feel the need to be with my husband after work to give him some companionship.

I am a nurse. I work at a large hospital in Kansas City. I became a nurse in 2006 after returning to school to earn another degree. I needed the degree in order to work as a nurse. I really didn't want to go to school again....

Wait. Strike that. Let's be honest. I loved going to school again. If I had my druthers I'd be in college forever. I enjoy learning, I enjoy working on projects. I like the camraderie of fellow students. I like having well-defined goals. I like research. It's just not a sustainable way of life. I thrill at the rush of "living poor" successfully - finding bargains at the thrift store, clipping coupons, living without cable TV, staying home and listening to the radio for entertainment, taking advantage of student discounts.

OK, I've confessed. That's out of the way, I will continue on my topic of the day. My typical work day. I intended to do the whole day in this post, originally, but it got too big. Here is part one: early morning.

Early morning

Getting to work

I get up at about 0500, shower, dress, pack lunch and snacks, and go to work. It is a 25 minute drive - about 35 minutes door-to-clock-in. I always wear a cross necklace to work; this is because I need God's protection and guidance in my work, and because God called me to to become a nurse. I wear scrubs, support knee-hi hose, athletic socks, and comfortable shoes. I wear athletic shoes, mainly walking-style shoes.

I also need my watch. I have el-cheapo watch from walmart - digital, water resistant, lighted. It displays in Military time, which is how we chart. Then, I don't have to think about what time to write on my charting - look at watch, copy. It would be nice to have a good watch, but there are some places at work I might drop my watch from which I would not want to retrieve it.

I try to get to work about 10 minutes early so that I can do some of the set-up things I like to do before I need to start working with my patients. I also try to help the night nurses get out of work on time, by taking over care of my patients promptly. They do the same at the end of my shift. Boy, do I appreciate that!

Getting ready for the day

After I clock in, I prepare my body for the day. I have a locker in which I place my valuables and stash my supplies. Here is how I get ready.

1. Gear up for the day - On my person, I have a stethoscope, locator badge, sharpie pen, black ball-point pens, alcohol pads, carpuject (a device for dispensing certain kinds of IV medicines), and bandage scissors. I usually take a jacket with me in case I get cold. I have a bottle of water. Finally, it is essential that I have a tube of lip balm in a pocket. My lips get dry.


2. Go on the unit.


3. Find out my patient assignments and from whom I need to get report, if any


4. Stake out a claim on a computer station that will be mine during the day. Put my non-pocket stuff at this station and log in to the computer. My stuff include a 1-Liter bottle of water and a jacket.Everything else I mentioned above stays in a pocket, around my neck, or clipped on my clothing.


5. Sometimes, I have time to check email before the race begins,


6. Until recently I printed out specific sheets of paper that help me through the day. One is called the "brain" on which I take notes about the patients. These include name, age, room, diagnosis, medical history, parameters that a nurse needs to know, upcoming things for the day (i.e. tests, discharge, etc.) and significant lab results from last night. The other paper is a cheat sheet for a patient profile, a questionnaire for new patients.




• I don't do these things now because just this week, we switched to a computer charting system. I'm striving to live without paper!




7. Pick up and log into Vocera
   Vocera is a little voice-recognition walkie-talkie device worn around the neck.

Then, I can get report from the night nurses and start the day. The race is on.

The Unit

I work in a unit that supports the cath lab and the electrophysiology lab. Our patients are mostly heart patients. Most of our patients come in early in the morning and go home either that afternoon or the next morning. We do the prep and recovery for these patients. Our goals are to keep the patients safe and to supply these labs with a steady stream of patients. An idle doctor is not earning money for the hospital! Oh yeah, and the better we do our job, the more patients will get the interventions they need sooner. That, too.

The Patient Prep

Given these goals, a patient prep is our first priority. To get a patient ready, we have health related questions to ask them, consent forms to be signed, IVs to start, and we have to fill in any gaps in the preparation process that the doctor or the patient may have missed. We have to shave their hair in various areas of their bodies. We have to get a patient weight and a full set of vital signs. Sometimes we have to give pills (Aspirin, Plavix, Valium for the nervous patient). Often we have to get finger-stick blood sugar reading, draw labs and get them down to the lab ASAP. The patient can't go to procedure until the labs are reviewed. We start IV drips, sometimes more than one. I also have to assess the patient and mark their pulses on their feet. We monitor that later in the day.

In theory, we have to have this all done in 30 minutes or less. After a year at this job, I am still not that good; however, in my own defense, there are a lot of factors over which I have no control that impact my speed in a patient prep.

Unfortunately, as the nurse, I am still responsible for these things. That's one of the frustrating things about my job.

The Overnight Patient

If a patient has stayed overnight, it is most often the case that they will leave early in the morning. We are usually urged to get them out as fast as possible. My personal goal is 1000, but the unit goal is 0900. Between 0700 and 0900, somehow I need to do all of the following:

• Do a safety check - make sure the patient is who the chart says they are, she isn't going to trip on anything in the room, etc.
  
• Assess my patient (listen to heart, lungs, belly, assess incisions from yesterday's procedure, monitor pulses and assess pain).
  
• Gather vital signs.
  
• More often than not, get a finger-stick blood sugar. Everyone is diabetic these days.
  
• Run an EKG strip from the monitor and analyze it.
  
• Fix any equipment problems, such as adjusting heart monitor leads.
  
• Make sure they order breakfast.
  
• Administer the morning meds. Safely and accurately, of course.
  
• Get them to any tests/consults before they go home. For patients who get a pacemaker, they usually have to go downstairs to get a chest xray to verify the placement of the leads.
  
• Make sure the doctor or nurse practitioner comes by to assess the patient
  
• Watch for the official release from the MD or NP
  
• Discontinue the IV or IVs, remove heart monitor
  
• Complete the discharge paperwork in the computer
  
• Go over the discharge instructions with the patient, give them their copies of the instructions, and get a signature. Make sure the patient has any other items from their procedure (identification cards, portable monitors, etc.)
  
• Give the patient their prescriptions
  
• Take them downstairs in a wheelchair to meet their ride.
  

That's a hell of a lot! Then after they go, I have to complete their chart and give it to the secretary for break-down. Indeed I have assistance, but our Nursing Assistants, like us, have priorities to prep the new people coming in. I usually do most of the above things myself.

Now, you must realize that I usually have 3 patients. It will typically be either 1 new patient and 2 discharges, or 2 new patients and 1 discharge. It's loads of fun when the new patients are scheduled to arrive at the same time and the discharge patient and his family are whining to be discharged.

In my comprehensive list above, I have not accounted for some of the variations of these tasks, such as new orders on a discharge patient (e.g., his serum potassium is low, please give him extra potassium), or a medication is missing (call pharmacy!), the unit coordinator is breathing down my neck to discharge patients because we need the beds. Something is suspicious on the patient that needs to be reported to the doctor (which the patient didn't say anything about when the doctor was in the room). Special patient requests like a cup of coffee. The patient failed to mention s/he needs a new prescription for a medication. I have to finish any paperwork the previous shift did not complete.

Mornings go by very quickly on my unit. This is when the doctors are doing most of their procedures so patients are coming and going all of the time.

Coming next time: The workday, part 2: late morning and afternoon.

Fall color and impending doom

This morning, I took some pictures of a pretty maple tree we have in our front yard. These pictures are kind of artsy, in that I took close up shots of the interior of the tree, so that all you see are brances and firey red. The leaves on this tree have turned a uniform orangey-red and it's just beautiful. It has done this in previous years, and it has been this color for a few days now. Yet, it still catches my eye as I walk by the window. It's so vivid!

I appreciate fall, but I do not like fall. I enjoy the cooler temperatures, the drier air, the dramatic swashes of color in the foliage. Autumn is the harbinger of winter, and I cannot ignore this point. I dislike the cold and the dark.

I get depressed with the lack of light. I chill very easily and I don't like being cold. This is why I hate winter.

I have tried to make peace with winter. When I lived in upstate New York, I figured I had to, as a matter of survival. I ice skated (which I actually know how to do, thanks to phys ed class in college), and I took Cross Country ski lessons. I bought the most expensive coats and gloves I could afford. To no avail. Even with my heart pounding in physical exercise, my fingers and toes can be numb with cold. Yes, they are wrapped up in several layers of gloves, socks, mittens, and boots.

My solution to this hatred was to move south. For nearly 15 years I lived in North Carolina, where I enjoyed balmy temperatures throughout the year. OK, I'm exaggerating - it did get cold for about 6-8 weeks, and then it was over with. And when it did snow or ice, everyone shut everything down. No work, no school, nothing. I consider this very civilized (I do concede that this is impractical for more northern parts of the country).

Woe to me when my husband decided to take a permanent position with a company in Kansas. Once again, I am finding myself having to make peace with winter. This time, I am finding ways to be happy while being inside. Winter is a productive time for quilting and sewing. Maybe my utilization of Netflix will improve.

If my blogging has a tone of gloom and doom for the next 5-6 months, the weather may have something to do with it.

A Birthday and an Achievement

Thursday was my birthday. I am now 42. I have come to dislike birthdays, although I still enjoy treating myself with presents and getting attention from friends and family.

My achievement was that I found out yesterday that one of the patents that I had applied for in my previous life had been awarded. I am an inventor of an original software process. Technically, I am a co-inventor - I don't want to minimize that. Two of us developed the process and implementation. Both women, interestingly enough.

I am pleased this patent was granted. This one I actually invented and I do believe it is original. There was another one I co-invented with 4 other people. My role was much smaller, and I don't think the process is exceedingly original. But, there was a patent frenzy back in the late 90s and early 00s, and my corporation got caught up in it. I do put both of these things on my resume. It impresses people.

It also earned me about $1000 in bonus money. Nice, but long gone!!

I am torn whether to mention this award to my boss at my current job. On the one hand, it's pretty cool, and unique. On the other hand, it is some degree of shameless self promotion. This particular patent has nothing to do with my current job. As a result, I kinda feel like I'd be saying, "look at me, I was little miss sunshine when I was 5 years old!' (I wasn't, by the way). Still, it's an accomplishment and I'd like to share with a few people.

I struggle with my ego. Deep down, I think I'm very egotistical. I think I'm great, beautiful, talented, smart, and funny. Logically, though, I conclude I'm about as common as they come (except for the no-kids thing). Everyone is great, beautiful, talents, smart, or funny, all of these things, and many more. I am conflicted between real values and the world's values - am I great because of my achievements (world value)? am I great because I am one of God's beloved children (real value)? Am I nothing because I'm a common person living in the USA (world value)?

Another example of where I've been conflicted was when I found a writing contest in the newspaper. They were looking for several writers for a column about people's faith journeys. In some ways, I think my journey has been unique. I thought it was something I should share. Maybe it would inspire or comfort someone. I sat down and wrote one of the essays for the contest. But the more I thought about it, I wondered if my motivation was really self-aggrandization. I wanted to be published and have my picture in the paper. Maybe I really just wanted the admiration of others over what a superb Christian I was.

So I never sent in my essay.

I seem to have the urge to tell my story, since I'm writing here. However, I've told no one about my blog. Yet.

PS. I need to write about my faith journey here.