New Year's Resolutions

I think New Year's Resolutions are alright. I have made some in the past and stuck with them to some extent. I try to make them something that I truly want to achieve and that is realistic to achieve.

I have an interesting "candidate" resolution for this year. I read in the paper an article on Thank You notes, and in which the author quotes a mentor of hers that she should write a thank you note a day. She protests that she doesn't think she has that many people to thank! Then you are just not looking hard enough, is the reply.

This thought has captured my imagination. Indeed I believe I have enough people to thank for one note a day. I probably have even more than that! I am truly blessed...even though I forget that every so often.

Should this be my New Year's Resolution?

Realistically, I don't think I can commit to one thank you note a day. I could probably sustain one thank you note a week. One a month would not be enough.

There are several goals in such a resolution: increase my awareness and make me more sensitive to appreciating those around me, establishing a writing discipline, practicing penmanship (I type most of the time anymore), nurturing my relationships. Seems like a great thing to do!

One thank you note per week. That's a lot, really. Can I do it? Should I commit to it? What do you think, dear reader?

This Christmas

I was supposed to work. Once again, the phone rang at 5:00 am and I was canceled. I was delighted again, not as much as on Christmas Eve. The reason was that I had a long day at home previously and I was ready to be cheery for a few hours on Christmas Day. It's OK. I think my husband was happier that I could stay home, although he could do without the 5:00 am phone call.

I got bored yesterday. It was gray out and windy. We did have some nice gifts from each other, friends, and family. My husband bought "us" Guitar Hero and we played a bit. I am fantastically bad at this games - computer games rarely capture my interest anyway. I'd rather read a book, work on a quilt, write a post to my blog, knit, cook, exercise, grocery shop....well, just about anything. Nevertheless, I tried it and I admit, it's kind of fun.

I am still fantastically bad at it though. You'd think I'd be good at it because I'm a musician. I bet I'd be good at it if they used the language of music rather than the language of gamers. I know what a syncopated rhythm looks like in notes and time signatures, not in matching the dot to the target.

We went out to a friend's house for a few hours. Against my better judgment, we went to a friend's family gathering by a quick casual invitation, after I'd mentioned we had no plans. (I know, I know, what did I post just a few days ago???). It was OK. I had been looking forward to it because my friend had said the family gets together and plays games and eats all day. There were few games to be found. I goofed around with Dance Dance Revolution vs. a 10 year old, and half-heartedly tried to get a game of Scrabble together. They talked among themselves, although early on, some of them did interact with us a lot. The guys were all absent, putting together a table saw down the basement.

The chemistry wasn't there. We left, then drove out to the Plaza to see the lights. It was pretty.

When we got home, we went to play Guitar Hero again. This time, we tried "quick play" instead of training mode. I was so bad...the computer generated crowd booed me off the stage. It's tough when a virtual audience things you suck. And it hit me the wrong way.

Eh, it's over. The gifts are given. Today I've been taking advantage of the sales and enjoying the shopping therapy. I got some great deals!!

A Gift of Grace

Yesterday was the third Tuesday in a row when bad weather came in. Yesterday, we had freezing rain, high winds, culminated by snow starting late at night. I awoke this morning to about 1 inch of snow on the ground. Since I was scheduled to work, I needed to get up early, get through my yoga practice, and plan to leave early to compensate for the bad road conditions. Our street is completely covered with snow, although the main roads are likely to be cleaned up.

Then the phone rang. Very low census on the unit today, the overnight unit coordinator is canceling nurses. Would I like to be cancelled?

Would I!

Any excuse not to go out in that weather!

Oh, this has delighted me! I can finish cleaning the house today. I can work on my quilt! I can go to Christmas Eve services at church tonight!

And even better - last night I had been searching the American Patchwork and Quilting website for a copy of the pattern for the bed quilt I am working on. I had clipped the pattern from the magazine and brought it to work to show my friends my project. Yet, somehow I lost track of the pattern and it disappeared!

The American Patchwork and Quilting website (www.allpeoplequilt.com) had it! It took a lot of searching, and I ended up finding it under "Products" on BHG.com. They charged some money ($6 plus tax) for it, but at this point, after having completed all 80 blocks but still needing the directions for sashing and borders, of course I would pay for it.

Here is how you find a back issue pattern from APQ. Go to www.allpeoplequilt.com, click on "Printable Patterns," and then click on a pattern that you have to pay for. This will take you to the product area. (Don't worry, you're not buying the pattern you clicked on, just browsing) From here, you can search for another pattern. There may be a more direct way to get there, but this worked for me. I also knew the name of the pattern - I don't know how well the search works if you are trying to describe the quilt, only.

You'd think there'd be some instructions on the website. It's gotta be a common request.

I am still scheduled to work tomorrow and it is possible I'll be canceled again. I can hope, but it's OK if I do have to work after all. It's only a half day, and I'll earn a lot of money, anyway. I don't have anything else to do on Christmas this year. I will be making a difference to the patients who do have to stay tonight.

And a few more thoughts on goals

Interestingly, as I look back on my life, I observe that my life doesn't just happen to me. Serendipitous things don't occur randomly.

Only rarely do unplanned things happen. So far, my very few unplanned life events have been negative.

Like the time the apartment house I lived in had a fire. Wiped out the place. That sucked.

My life is characterized as a series of events I make happen. I never fall into things, like unexpected pregnancies, fortuitous professional opportunities, random relocations, surprising social events. I make my own luck, I make my own future. For instance: I study, I pass tests, I earn degrees, I decide on a career I want, I become what I want to be. I wanted certain behaviors to stop, so I put myself in therapy. I wanted to get married (at a certain age) so I decided to date more of "the marrying kind." Now, I'm married. I wanted to sing more, so I took lessons and learned how to audition, tried out for a chorus, and got decent at it. Now I sing some.

I am comfortable with this. For one thing, I feel empowered, and I have no doubt that I am NOT a victim of circumstance. It's quite a luxury, really.

Life is more random than it appears to me, so I understand. To have an interesting, quality life, it takes my effort, and only my effort. I fear the randomness. I fear that wouldn't how to deal with it.

Sometimes I wish someone would take care of these things instead of me. It gets tiresome.

Oh, what the hell am I complaining about? I am so blessed.

See? This is the darkness talking again...

Update

No word from up above on my next journey.

The one that keeps resounding in my mind is the clarinet choir. I don't know how to start a clarinet choir, though. While I have some musical training, I don't know how to conduct, really.

Sounds like the right challenge, don't you think?

On this, the winter solstice, the darkest day of the year, I am seeking light. Direction, and light.

Sinking...

It's the winter, I'm sinking into the pit again.

I will keep persevering, I will keep taking my meds. I will try again to reach beyond.

I had a thought this morning about what makes me happy. A goal. I need a goal. I need a meaningful, lofty goal. I need something to work towards. I need a path to walk.

What's next? Professional? Art? Travel? Family? Education? Investment? Spiritual?

I don't know. Here are some things I have thought about.

• Professional: Another master's degree (in nursing this time).


• Professional: A new more challenging job.


• Professional: Pursue the ideas I have for developing original software


• Professional: Do I really want to teach nursing students?


• Art: Find a better singing venue than I currently have


• Art: Start a clarinet choir.


• Art: Get back into playing saxophone


• Art: Buy an alto or bass clarinet and get good at it. Find gigs.


• Travel: Plan the next international vacation.


• Family: Make one of my own.


• Education: Another degree? Really?


• Investment: Actually learn how to manage my money.


• Spiritual: More involvement in church


• Spiritual: Write spiritual literature - that is a book of devotions.

I will pray on it. I don't know where God wants me to go at this point. I need to identify one to commit to.

Stop the Fear Mongering

I am so tired of being reminded how we should all be afraid.

I just got an email from a casual friend warning me (and everyone on her extensive email list) of the latest so-called trick criminals use to carjack your car, steal your identity (because your purse is in the car) and come to your home and terrorize you.

Snopes.com says this story is false. Given the large type in the email with red text, I immediately agree.

What is it about this? Why are we so damn afraid? Why must we be reminded over and over again to be afraid? Everyone is out to get us? Why?

Yes we're all vulnerable. Yes bad things happen. So what? Being afraid of everything isn't going to change those facts.

It's just crazy. Stop it already.

Feeling Abandoned

Sometimes at work, I feel abandoned and unsupported. I feel like no one is around to help me and I have to provide total care for all of my patients. I can't rely on the doctors, the aides, the technicians, the secretaries, the other nurses on my unit or on my unit coordinator (charge nurse). I really don't like days like that.

What happens from time to time is that because of the room assignments of the patients in the unit, I end up all by myself. I am not physically near any coworkers. Naturally, people congregate where they're working, and when I'm on my own, then there's no one to talk to. I get lonely. So it was with yesterday - it laid the groundwork for a bad day.

Yesterday an unusual thing happened - orders for a patient written 12 hours earlier had not been entered in the system. That means medications didn't get sent up for that patient, and orders for a chest xray didn't get entered (so they didn't come get the patient for the xray), lab orders weren't entered (so the labs weren't drawn). Human error and unfortunate timing contributed to the oversight. Here is what I think happened:

• The patient came back to our unit at shift change. He came to the unit at about 3:00pm, promptly went to procedure and wasn't seen again until 7:00pm. Things are vulnerable at shift change.
  
• I was involved with a sheath removal in another room right at the time the patient returned; I wasn't available to receive the patient. I had another nurse take report. She did, and scribbled it down on a sheet of paper in her own short hand. She left the sheet of paper on the desk for me and went off to deal with issues for her own patients.
  
• The night nurse came on at shift change. I gave report from my limited experience with the patient and the scribbled report.
  
• The night nurse was a float nurse. She doesn't normally work on our unit. She doesn't know intimately how we do things on this unit. She probably assumed the orders were taken care of.
  
• The unit secretary on that night was sick and not very "with it" that night.
  
• Since the float nurse didn't know how the unit works, she didn't realize certain things were missing for this patient. For example, she didn't get concerned when they didn't come get the guy for the xray. She didn't think it was unusual that there were no lab tests scheduled. She probably didn't wonder why the second antibiotic dose didn't show up from pharmacy. And, in her defense, why would she? These things are supposed to be taken care of.
  
• Another contributing factor was that when the patient came back from procedure, doctors, nurses and family were buzzing around in a tizzy. His procedure was complicated (not dangerous, though). It is likely that the chart got picked up and put down many times and somehow never made it to the secretary's desk to be entered.
  

The end result is that the secretary in the morning caught the fact that the orders had never been entered. Ah, that explains why it is 10:00am and the patient still hasn't gone down for his xray! (It is usually done between 6:30 and 7:00 am.) I felt bad about it, and it rather ruined my day. No one yelled at me, at least.

But how can you not feel criticized when doctors or nurse practitioners ask you "where is the INR?" (lab test)?

Guess who gets to pay for the mistake? Me. The nurse is ultimately responsible for the entering of orders (accurately), and the carrying out of doctors orders. I oversee the entire path of care the patient experiences during my shift portion of the hospital stay. Yes, I have help, but I am the responsible party. That is why I have legal registration and why I supposedly get paid the "big bucks."

I am also responsible for checking the doctors orders, in that sometimes they forget things (yes, in fact I do want an EKG after procedure! I'm so glad you noticed!) or check a box to give the patient morphine (Oh, silly me. The patient is allergic to morphine!! I didn't really want to order that). One phone call is not a huge deal. After the 50th or 60th call, you get tired of checking up on them. Just do it right for God's sake.

The docs get complacent that we will catch their errors. When we don't catch their omissions/errors we end up paying. And we get the consequences - drop everything and draw this lab test now! Stop what you're doing and call down to xray so this patient's xray gets done! I don't care what you're doing now, drop everything and do what I need, says the doctor, because I cannot be slowed down.

Eh, it is what it is. Mostly the system works well. Sometimes things fall through the cracks.

On Autonomy

My workplace is certified as a Magnet Hospital. This means that we are supposedly a great place to work for nurses - and other things, follow the previous link for more info. In general, it really is! One of the principles of being a Magnet Hospital is supporting autonomous practice for nurses.

I don't know what I think about that. In reality, autonomous practice is a balance between doing what the nurse think the patient needs and the legal scope of practice. Legally, registered nurses can't do some things (like prescribe medication). Where I work, I have very little autonomy. Personally, it's OK with me, but the lack of control over how my day goes gets frustrating.

None of us has control over when patients are scheduled, when they arrive, when the doctor takes them to the lab, when they come back from the lab, and when they go home. My manager feels that we shouldn't have input in these things - it is our job to accommodate and serve. She is the conduit through which we communicate with the organizations that make these very decisions. Our input can stop with her if she doesn't advocate for us. This happens.

For the most part, the requirement for these events is "right now." Well, hell, I can't be in two rooms at one time. I can't be giving an insulin shot to patient X while I'm gathering a medical history from patient Y. Everyone wants it now. And everyone's priority is the most important.

There's only so much I can do. The so-called solution to this problem is "prioritizing" and "delegating." Many times, establishing priorities works, but it is not 100% fail proof.


Thanks for listening. I needed to write this down to feel better. Keep in mind that I still like my job and like my career. It is like anything in this imperfect world. You know.

December Post

I don't want to abandon my discipline altogether. I am making myself write today. I have no burning issue to discuss but let's see what develops.

On Christmas

Ever wonder what child-free people do for Christmas? We are out there. We aren't really to be pitied about it - despite the mainstream media's emphasis on family, the child's wonder at the holiday, toys, and tradition passed from generation to generation, adults without children celebrate in as many ways as there are people. There is a whole world out there for adults outside the so-called traditional lifestyle. And it's pretty good.

We don't just sit around lonely and bored, longing for the Norman Rockwell story. In fact, some of the stories I hear about the traditional family get togethers are just horrific. Drama, old conflicts brought up, alcoholic uncles, unrealistic expectations, etc. etc. Oh please.

Some of us work. This year it's my turn and I will work Christmas Eve and Christmas Day (but only a half day is needed on Christmas day). People don't stop having heart attacks, going into labor, developing stomach ulcers, and succumbing to diabetic ketoacidosis, just because it's Christmas Eve. Someday, it may be you. Thank goodness we are there.

Some of us focus on the religious aspect of the season. As I get older and learn more about the history of the church, the less I believe that 12/25 actually was Jesus's birthday. Nevertheless, I think it is important to mark this event and reflect on the religious significance of this single, profound human life. December 25 is as good as any day to pick for it, I suppose. I am fascinated by the idea that God came to us as a baby, a common person, a poor person, even. In my mind, that makes sense. In worldly logic, it does not make sense. Such is the mystery.

I really like the religious music of the season, too. There's some beautiful stuff out there.

Some of us visit with family and enjoy our relatives. Some of us provide company and friendship for older relatives in addition to younger ones. You know, throughout history there has been a tradition of the unmarried aunt or widow in the family. Such women have always been important to families. I don't know so much about the single men, though. Societies regard them with suspicion, I guess.

Some people do have to confront the depression and frustration of being outside the mainstream.

Others take the day to do something they enjoy. Still others relish the unusual situation of life slowed down, for one (or two) days a year.

I don't mention to people what I do on the holidays to my friends and colleagues all that much anymore. Sometimes I just use vague terms, then refocus the conversation on them. I don't want to have to defend what I do or deal with a last minute invitation to join their family. (Ugh. That's awkward...). If the event had been planned to include me, hey, no problem. It's fun to see how others celebrate.

I don't begrudge society for promoting a mainstream image. It is necessary to keep our society going, to keep people to conform to the prescribed path in life, to procreate, to buy things, to establish traditions. It is what it is. If everyone were like me, we'd all be gone in a generation. I simply support approaching diversity with compassion.