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.

How We Communicate

I am teaching students again and loving every second of it. There is something about seeing the spark in one's eyes when the pieces are connected and watch the growth of a student over time. One of them this week asked me, "What is it like when you have a difficult situation? When you go home does your husband understand?"

This was a great question and I reflected back on some of the emotional moments I carried over the last few months. He always listens and is always there for me to vent about my day or ponder questions of life. He wants to understand but cannot always understand what exactly happened because he is not in healthcare, in the same way I can read his papers about geology and engineering and correct punctuation, but the concepts are way over my head to assess the accuracy of the paper. This is not a fault on either part, it is just an aspect of our occupations that are better understood by those in our field. A group of geologists stayed at our house this week and Caleb was so excited. "They understand me!" he exclaimed. This was no blow to me, but simply the fact that they speak the same language (geology).

I am fortunate that my best friend is a nurse. She gets things on a different level and is a sounding board when things get rough. I can express my feelings, concerns, frustrations, and she speaks nurse. My husband refers to it as "nurse talk" which is inevitable any time we are together.

Nurse talk expands beyond the aftermath of a day into the clinical setting itself. Nurses communicate by action and the way they communicate with their patients. I observed the care of a few ICU nurses recently that touched me. In the ICU nurses are very used to talking to their patients at all times, intubated or not. In observing one nurse care for a patient, she effortlessly spoke to the intubated, sedated patient dictating her care. It struck me as I had forgotten to speak to this patient in the midst of the tubes and lines I was managing. I then watched the husband take her hand and speak to her as if she were alert.

They can hear. They may not be totally aware of surroundings, but they say they can still hear your voice. It was a reminder to slow down in my day and remember to see each and every patient as a person every time.

Did I Forget You?

Start the morning with one patient who has been waiting for a bed several hours and is still heavily intoxicated.

Vitals are stable, patient is sleeping: Respiratory Rate even and unlabored, no s/s withdrawal or agitation at this time. 

An hour passes and now there are two more patients. I run around ensuring labs are sent, urine is collected, patients are assessed and comfortable. I run in to hang the bag of fluids ordered on patient #1.
Still sleeping, RR even and unlabored, but awakens upon entering. Speech slurred and mumbled but asks for a blanket. Warm blanket provided and patient back to sleep. Still waiting for a room.

One patient discharged and another in by ambulance. Patient one now has their call light on.

Pt requesting food. Gatorade and sandwich provided. Still waiting for bed assignment. Fluids running, vitals stable. 

Now I have four patients and one pulls at my heart. I am slightly more attentive than normal and tend to assess their pain more than the average patient. They make me laugh and I connect with them. I am extra attentive to their needs. I'm attentive to all my patients, right?

Patient is more agitated and tremulous, Ativan administered per withdrawal protocol. 

Five patients now and I'm getting in my steps for the day up and down the hall. Meds passed, splints applied, vitals checked...My "favorite" patient at the time was up for discharge. I wheeled them out the door proud of the care delivered and holding a connection made in my heart. I pass off report for a lunch break...

Did I forget you? You were sleeping and stable last I checked...you got a floor bed while I was at lunch and had wet the bed, sheets were astray, and you were confused and unkept.

Did I forget you? Your socks were filthy, blankets were on the floor, your gown wasn't on anymore.

Did I forget you? Did I neglect to pay attention to the details because you were asleep and drunk? Did I give you the time I gave to each and every other patient? Did I give you time like I gave to the patient that won my heart? Would I have offered to change your dirty socks and spent more time chatting with you if you were someone else?  

When I learned of the events my heart broke inside. I had been so proud of my care for my patients and yet one had fallen through the cracks. I like to think I care for each patient the same way no matter who they are, but forgetting you this time makes me more conscious of my priorities and actions.

I'm sorry I overlooked you that day. I hope you are healing well and I thank you for reminding me what it means to treat each person as I would want to be treated or would treat a family member.

Next time I promise you will not be forgotten.