From the Penalty Box

The last three weeks I have been in recovery from my meniscus surgery with orders for limited mobility and movement. Luckily I have been able to work in the front of the ER triaging patients as they walk through the door. I register them and assess their condition and then appropriately place them in a room behind the swinging doors to the ER. 

I love to be constantly on the move at all times, and recovering from knee surgery is anything BUT running around. Confined to my chair in the front of the ER with minimal walking has helped me heal, and is fondly referred to as my "penalty box", as it separates me from full patient care and "playing" with my coworkers.

While not the most exciting part of the ER, I have been able to draw great insight from the last weeks up front and had a little time to take a "time-out" and reflect. I recognize that every day presents an opportunity for growth. Being new to this role in the department it was an opportunity to really learn my strengths and weaknesses, reassess, and try again the next day. There was something to take away each day even if it wasn't taking the most critical patient in the department. 

The second was the value of a first impression. 

When you walk into the doors of the ER you typically don't feel well. You're scared, you're nauseous, your head hurts...etc. You pass through the metal detector and have to be cleared by security to then approach the nurse's desk for assessment and admittance to a room. This can be a scary passage for the patient, and at times an overwhelming position for the nurse when there are no beds available and the waiting room is filling up with multiple patients waiting to be checked in. 

I am the first healthcare provider you meet. You are uneasy and uncomfortable and the least I can do is give you a smile and assurance that I see you, I care, and I am going to help you. It doesn't do you any good if I appear annoyed, angry, or frustrated, or if I don't treat you with respect and kindness. While it can be a high tension position with lots of emotions in the waiting room, it helps you if I remain calm and listen to your concerns. 

Perspective is everything. 

From the eyes of the nurse I want to make sure no one needs immediate life-saving intervention; however, if I had my loved one in the waiting room, I too would be anxious to have them seen first and ensure the nurse didn't forget I was sitting there. Fear not, I see you, but only have so much control over the accessibility of beds and higher acuity patients are seen first. 

You sometimes yell, you sometimes lash out, you can be rude, you may have left the emesis bag behind, you may pace angrily, you may even choose to leave, but I promise I will be kind to you. I promise not to yell at you, I promise to give you a fresh emesis bag, I promise to respect you, and I promise to listen. I will watch you and assess you and intervene when necessary. I will advocate for you and I will get you a room as soon as possible. I will smile and I will remember that no one ever really wants to come to the ER. 

In the front or in the back I promise to remember the last three weeks. I will smile, and make it a point to make sure you are informed, aware, heard, and cared for.

I promise to treat you like I would want to be treated if I walked through those doors. 

In Your Shoes

I am the nurse, you are the patient. That is normal, that is how it is supposed to be every day I walk in to work. This normalcy can sometimes numb me to what it feels like to be on the other side. To feel tied down, needy, a little scared, and out of control. 

This week you were the nurse and I was the patient. First you asked me to exchange my comfortable sweats for a gown, complete with non-skid socks and a fall risk bracelet. I felt vulnerable and uncomfortable. I was a little snippy and recoiled immediately, realizing it was my vulnerability speaking and you were being nothing but nice to me.

Then you had to start an IV and it took three times. This was my fault for being dehydrated and having been NPO since the night before, but I wished you had just poked first at the vein I showed you. I smiled because I've been there and a nurse hates not being able to successfully get that first stick. I felt the vein blow and realized how much it actually hurts. 

You, the doctor, and the anesthesiologist approached me separately and confirmed that I understood the procedure and that all my questions were answered. This was nice. I felt as comfortable as a pre-op patient could and safe knowing my identity and surgery site had been confirmed multiple times. You knew I was cold and automatically draped with with a warm blanket. That also helped me feel better.

We wheeled into the frigid OR and I again felt uncomfortable as the nasal cannula was placed in my nose. The smell and taste of the oxygen made me queasy. I began to talk to the anesthesiologist and begged him not to over-sedate me. How much propofol are you using? I'm really trying not to be an obnoxious patient...they all laughed. All of a sudden the room became blurred and began to spin. 

What did you just give me???!!!

 That was some Fentanyl, he responded. I didn't want that! I hate you I moaned. I had never felt so dizzy. I also was miffed that he had administered the drug without warning me first. At least he had the courtesy to give me Zofran first. Again, feeling vulnerable and completely out of control. Then I was asleep. 

I look back and I think of you, the patient. I forget how scary and vulnerable it can feel to be tin your shoes. I forget to listen when you tell me which vein always works when you come in. I forget to bring you that warm blanket I promised you 20 minutes ago. Do I always explain all medications thoroughly enough before administration? Do I give you the benefit of the doubt when you lash out because you are afraid and don't know how else to respond? 

This week I was put in your shoes and I will take these lessons with me and remember next time what it's like to be you.

Have You Been Affirmed?

There is nothing that feels better than someone coming up to you, looking you in the eye, and sincerely telling you that you did a good job. It is human nature to crave approval from those around us and positive affirmation goes a long way. 

It had been a long, hard day and I was feeling insecure about my abilities and the outcomes of my 12 hour shift. High tension-high stress days can do that. I was ready to clock out and hang up the stethoscope for the night when the charge nurse stopped me to say thanks and proceeded to sincerely affirm my work for the day. It could not have come at a better time. I don't know if she'll ever know how much I needed that on that particular evening.

When was the last time you told someone they did a good job? When was the last time you complemented someone on what they were doing or simply who they are? We live in a culture that constantly beats us down and tells us we should be better, that we should be something other than who we are. 

 What if we practiced affirming each other and building a culture that appreciates who each one of us is as an individual and what we bring to the table? Try it sometime. Make it sincere and meaningful, but don't be afraid to tell someone that you appreciate them or something they did. If it makes your day, imagine how many days you can make by being mindful of the work of those around you.

Work, school, friends, family...whose work do you take for granted? That would be a good place to start.

What's in Your Control?

I never thought this would happen to me. I NEVER thought this would be me. Look at me! I'm a mess. How did this happen?

While they were under the influence of a large amount of alcohol, this patient's words rang so sincere and true through the tears. Have you ever looked around at your life and thought How did I get here? or Why Me? Maybe the circumstances were in your control and maybe they weren't. For this patient, they had passed the point of control and the was rock bottom. 

I can't imagine how you feel and I don't know how you got here, but the reality is that you are here and we are here with you. We are here not to judge, but to help you. The fact is that you're here. No matter how you ended up at this point, we cannot change the past. All we can control is how we respond to the situation and our actions from this point on. 

 Tear-stained eyes nodded back at me with a glimmer of hope as I exited the room. My heart truly broke for this patient. I remember times in my life where I felt completely lost and out of control. 

None of us like to be out of control. My mind then went to the election. I struggled to read Facebook because there was so much anger in the words on the screen. The only control we had was our vote. After that, it was out of our control and we are now called to trust. While we cannot control the outcome, we can control how we respond. Let us respond with optimism, grace, hope, and trust.

Life each day is brighter, sweeter, and meaningful if you can find the light and respond with a smile.

What is Dignity?

"Though his mind betrayed him, they were able to maintain his dignity by giving him jobs each day that kept him busy and gave him purpose"

Dignity. This is a word that is being thrown around so much in light of the upcoming election, and one that is defined quite subjectively. Some believe dignity is giving someone the option to choose death when life gets too painful, and others define dignity as a loving, dedicated response to the situation at hand.

Many might peg Alzheimer's as a disease that takes away your life. That it takes away your purpose, that it makes life not worth living. This patient's life was not devastated by his disease, but rerouted to appreciate what could still be accomplished in his new world each day. While it was not the world you or I see each day, nevertheless it was a world where he woke up and had a job to complete to inspire those who worked around him.

 We don't always understand why things happen, and while none of us definitively know what awaits us on the other side, all we can control is how we treasure the gift of life in its final days.

There is something so beautiful about peace in the final moments of life. The stories about how many people the patient touched, how many years of marriage treasured, how many children left behind... I got a picture of not the patient with Alzheimer's, but the person in the bed loved and cherished who left a positive mark on this world.

Amazing grace how sweet the sound that saved a wretch like me. I once was lost but now am found was blind but now I see.

I sang as a prayer and with passion and hope for those left behind. I sang because in this moment we were honoring the life this patient lived and the dignity of the soul that had departed right in front of us. I sang to maintain the dignity, the honor and respect, of that moment. Sometimes there just aren't words that can be said.


There was no longer a heart beat, color was gone, and the tears streamed. So I sang. And God's presence filled the room as he took his child home. 



There are some patients and some circumstances that leave a mark on your heart. This man demonstrated what it meant to live a dignified life. He was empowered by his family to do simply that: live. May we all strive to inspire those around us by not seeing what we don't have, but making the most of what we do have, through good and bad. 

To everything there is a season, and a time for every purpose under heaven. -Ecclesiastes 3:1

The Last Place I Want to Be...

I wake up each morning and plan to go to the ER for work. This is normal for me. For the hundreds of other people that come through our doors each day, it is the last place they anticipated spending their day, and sometimes I forget this. What I see as a problem with a simple solution is often to the patient a devastating and sometimes life-changing event. 

Traumas had been rolling in and out all day and this was yet another. The patient was stable, but confused, and the CT scan was indicative of bleeding in the brain. I was concerned for the patient's prognosis and unsure of if he would return to baseline metal status after inpatient treatment. When family walks into the room the one thing you want to be able to convey is a message of hope, and sometimes there is not enough certainty to do so. This is hard. 

Is he going to be okay? That is the loaded question that every family member wants to know and I cannot always give the answers. What I can assure them is that the patient is stable and that he or she will be in excellent hands upon admission. This family member tried to communicate with the patient, and became tearful and pale. She sat down and stated I think I'm going to be sick. I grabbed her an emesis bag and sat down next to her rubbing her back. I assured her that right now, he was ok, and further treatment would help us understand more. I gave her permission to go outside and take a walk a take a breath. In that moment and looking at her face, I realized the weight of the situation. Not only was his world turned upside down, but so was hers. A simple outing out turned into a life-altering trip to the ER.

I think so often in emergency medicine, with critical patients, we have trained ourselves to just see the patient and focus on stabilization, treatment, and transfer. It is only when family enters into the room that this bubble is broken to recognize the person in the bed and the implications of the medical condition on the patient and family. There is a safety wall up to prevent personal feelings from clouding perspective during stabilization. I find that after the event I am able to step back and see the big picture. 

Every day I fear that someone I know will roll through the door of my ER. This particular trauma was a good reminder to me to remember what it means to go to the ER...that each and every time I enter a patient's room they hadn't planned it in part of their day. It is important to listen, empathize, and take a moment to put myself in their shoes. If my loved one was in the ER, what would I want to know? What would I want the nurse to do? How can I be a comfort to the family in addition to the patient I am caring for?

I work in the last place someone wants to be in a day, so how can I make that day a little better for all involved?

Half-full or half-empty?

Being a nurse is awesome and I love my job, but it is a trying profession. The beauty of my 12 hour shifts is four days off a week and paid time off that equates to about a month each year. Vacation allows for a fresh perspective, renewed spirit, and prevents burnout week in and out. No matter how much you love something, it’s good to take a step back to remember to appreciate it and remember why you do what you do.

I spent my week off in the beautiful woods of Yosemite National Park, a place that has been my favorite destination since I spent summers there as a child. While I live minutes from the beautiful Colorado Rocky Mountains, there is something about the seclusion of the Yosemite Valley, looking up at the gorgeous carved mountains, that makes my heart happy and content.

In the midst of our biking/hiking/walking adventures, my mom, husband, and I decided to treat ourselves to a hot meal in the rustic dining hall of the park’s Majestic Hotel. This was where we met Paul. Paul was a soft-spoken man late 40s to early 50s who greeted us at our table and took our drink orders.

He moved with deliberation and carried out his duties with a spirit of contentment, of someone who enjoyed what he did. His job was simply to fill drink orders. He was diligent in his work and moved from table to table ensuring that each person’s glass was always full, apologizing when it wasn’t. He was attentive to the point where I feared if I took a sip of water he would feel the need to refill my glass.

He was pleasant and inquired about our home city and plans for our vacation. We learned that he had worked in the National Parks for most of his life, living in the simplicity of the natural beauty of the park. He had no family or former job, but had found his niche in the simple task of serving others.

I couldn’t stop thinking about our interaction with Paul. He was different than most people. He was simple, humble, and kind. There was purpose in every move he made, joy in his step, and kindness and genuine interest in each question he asked. Some might call him stuck in one place, but I saw Paul as a light.

What if each of us lived our lives to make sure that the glasses of everyone around us were full? What if we moved with deliberation and looked beyond ourselves at all times to build up the people around us? I wouldn’t call that stuck, I would call it life-giving and purposeful. In taking time to step back and reflect, Paul reminded me to live with a spirit that is life-giving and to keep my perspective and glass full.