Imagine two Deloreans speeding side by side on a one-way road with you magically behind the wheel of both cars. Now imagine the road splits and each car heads off slightly in separate directions. Magically, on the road you are traveling to the left, space-time is at a standstill and you don’t age. You remain your youthful, unpredictable and naïve self. On the road to the right four years go by, you get older, hopefully a little wiser, and gain some new perspectives. There have been some highs and lows along the right road and you are changed. Now imagine these two roads begin to curve ever so slightly back towards each other until both Deloreans violently intersect back onto a reunited road and fuse together as one. This is what it feels like to move home after being away for so long: two versions of you trying to reconcile the miles in between. A month in and some of the novelty has worn off. It’s probably helped that I am up in Greeley, and while I’ve lived here previously for a season, it’s not somewhere I’ve spent an extensive amount of time. These aren’t my old stomping grounds. Traveling around Denver, Golden and Boulder in this first month back has been surreal, a constant game of déjà vu with the ghosts of my past lurking around every turn. I know these roads; I’ve driven them all a million times before. I know these paths and places stirring hazy feelings and kindling up long tucked away memories and moments both bad and good. At first it’s all seems the same, like time was on hold while I was gone, waiting for me to flip the light back on in Colorado with everything still sitting in it’s place. The trails, hikes, and hills are still here, but I’m not the same. I’m 20,000 miles traveled and four years removed from that moment when the road split and I drove away to the east. I’ve changed and it’s going to take a minute to realize how to metaphorically put back on the State that wears a little bit different than when I left. In the first week I’m nostalgic for the City of Big Shoulders. I want people to ask me about Her. I want to talk about the Second City that lifted me up to new and unknown heights. I miss it. Deep down though, I know what I miss most is routine, comfort and habit that provides the stable environment to move and grow. I’ll find it again here; I just have to be patient. Patience is what it always comes back to for me. In reality, the pause button is an illusion anyhow. The framework is the same, but the details are different. Some roads and interchanges are slightly modified, and new development is everywhere you turn. A huge new apartment complex cuts across my view of the foothills as I head west on 6th Avenue and enter the Golden town of my formative years. The light rail is running west and east and the state is bustling with people and promise. The years have been kind here in Colorado. My friends and family are thriving and carving out their niches in life just as I had been doing on the shores of Lake Michigan. Life’s gone on here too in the best of ways. Old smiling faces have welcomed me home, and some new bright faces have sparked my path forward. Chapter 29: Back to the Future, Back to School is in full effect and its time to settle in for the exciting ride and year ahead. I feel like I am cheating life a little bit: A big step backwards to launch forward to my destined future ahead. I’ve walked (or stumbled) this path once before on the manicured lawns and through the beautiful Tuscan Vernacular Revival that is the halls of learning on top of the hill in Boulder, Colorado. This time around I’m tucked out on the plains of Northern Colorado where the horns of real trains blast out into the night and peculiar scents may blow in on a soft wind. Farm living, with picturesque landscape views of the Purple Rockies. I drop my foot to the pedal of my car and blast down country roads to explore an untapped part of the Front Range. It’s revival of the soul and decompression from the Windy City in an unlikely cow town.
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1. Having a car in the City can sometimes be a hassle, but nighttime drives back up Lake Shore Drive after work on the South Side often put a smile on my face. The windows are down, the sunroof is open, and there's a cool breeze off the lake on a balmy summer night. The stereo's cranked up. The beautiful skyline is coming at me on the left, Soldier Field, Navy Pier and boats play in the safe harbor on the right. I'm in the home stretch coming around the big double bend, which is the best part because the road opens up and there's plenty of room to run.
2. Howling at the blood moon lunar eclipse with 1000s of other Chicagoans on the shore of Lake Michigan was a once in a lifetime experience. And while living with people stacked on top of people isn't one of my favorite parts, the convenience, never ending supply of good food and things do to and see, as well as that experience wouldn't be possible without it. Big cities can teach us about the strength of many. 3. Chicago’s architecture gives the City a unique flavor. Whether taking in the immense buildings from the powerfully low vantage point of a tour on the Chicago River, or pondering the stories old buildings with names etched into amazing stonework hold, it’s easy to stumble across amazing buildings, churches and homes whose style is distinctly Chicago. With limited space to roam, we built up, giving us rooftops to enjoy and a one-of-a-kind city to look out over as the el train rumbles by. 4. Wrigley Field is everything you would want it to be; old, nostalgic and full of tradition: Rooftops peer in on the action from Waveland and Sheffield, ground rule ivys, home runs from the other team tossed back on the field, billy goat curses... Just the other night I heard the crowd singing "Go, Cubs, Go" from my apartment a mile away after a walk off win. Someday they'll go "All the Way" and I'll be very tempted to come back and join the neighborhood fun. 5. The first really, really, really cold day of the year. It's a badge of pride knowing that we have what it takes to tough out the season and days ahead. Whether you like it or not, it doesn't matter, all you can do is embrace it, and I may honestly laugh at anyone in Colorado who tells me "It's soo cold out!" They have no idea. 6. Long runs down the lake front. I have great respect for the city planners who initially laid out the City and fought to keep the lake front wide open for all of us to enjoy. Chicago wouldn’t be the same without their vision, and I likely never would have got back into running or accomplished the Chicago Marathon without an amazing path to run down next to Lake Michigan. 7. Sundays at the schoolhouse: This ward has changed my life and I've learned so much from so many people here. I love meeting at the school and finding and feeling peace in a place where little kids were bouncing off the walls only 48 hours earlier. The quiet and focused sacrament meetings, great class comments, and the powerful testimonies each month strengthened and uplifted me while this was my home. Thank you all. 8. Can you remember the first time you rode the 'el'? Etched in my mind is the moment we get past the tall buildings and awning of the Merchandise Mart. We've popped out of the shadows and onto the Wells St. Bridge. I'm looking east at just the right moment at one of the most impressive sights I've ever seen. The morning sunshine glistens off the river and skyscrapers stretching down either side towards the lake. This is Chicago, and she is beautiful. 9. Trying to comprehend what was the lush dense forests and marshland that existed here before the city took root. I like to believe that what was once here was equally as impressive as the City is today based on my experiences in Chicagoland's forest preserves and golf courses. I sometimes like to imagine all the green running right to the edge of a pristine Lake Michigan and how amazing that must have been. 10. The rain: Whether it's the inner voice yelling "You have t-minus 5 to get inside before this sky starts falling", or being lulled to sleep listening to REAL rain storms pound the streets and sidewalks, the rain and storms in this city are something special and iconic that have left their mark. Today was a great day. Honestly its been a great couple weeks. I'm burnt out, exhausted and in some ways just holding a few pieces of life together, but today I've got a smile ear to ear baby. 2016 has been its own marathon, albeit a mental one. At times I've honestly felt like I'm wrapped up in something far bigger than I sometimes can even understand. The only way I could describe it is like this out-of-body experience where you are watching yourself and everything else happening around you. Only I am very much in-body, with my feat on the ground. I think the perspective I've really been seeing is God working in my life, shining the way at times while I've been on autopilot chasing down a dream. Of course that's 'autopilot" in the Tesla sense: Dialed in, but you best be believe you better be paying attention to the road ahead and be ready to make any course corrections when the lines on the road disappear. After all, ultimately we are in the driver's seat. It would be a mistake to give you the impression that this journey has been all peaches n' cream as I float on cloud nine or a magic carpet. It has been serious work, sacrifice, and plenty of uncertainty along the way. Interestingly and probably not really surprisingly, there was a stretch where the closer I got to firming up plans and actually setting things in motion to move, in which self doubt began to creep back in on the periphery. My online pathophysiology class was killing me, I was underwater with end of quarter work at Tesla, working Saturdays at the hospital, and the reality that I actually needed to start getting ready to move in six weeks was acute. In the heat of all that came the thoughts. "You can't be a flight nurse." "You don't know enough." "Your pathophysiology game is going to be weak." "You took this course online, you haven't learned enough." "You're too old." "You should stay at Tesla, you're going to miss out if you leave." While there may be some validity to a few of those statements, in the end all they really are is negative chatter being thrown my direction in an attempt to take my eye off the road at a crucial moment. I think I've learned that the best defense in these moments is to have a counter list of everything that has clicked in to place and pulled you to this exact moment in time on your journey. This list is your #55 that can say, "No,No. Not in my house. Not today." When we look closely at life, we can practice seeing God work in our lives in big and small ways. Our end of the deal is to hopefully notice these moments, express gratitude for them, and try our best to store them away. This recipe waters our faith in our path and pursuits, and in ourselves. I think it's when we are demonstrating this formula most effectively that we are able to see things lining up in our lives in even greater detail.
This doesn't mean we will have every turn illuminated, and there will be long stretches, even when we are doing our best, where we don't remotely feel that connection and direction.. The reason for this is because sometimes we have to act. Sometimes we have to take the first step into the unknown. We have to put in the work. The beautiful part comes when we get the feedback and confirmation that we are moving in the right direction. Personally with my journey, I have found those moments come relatively quickly after I've taken a few meager steps further into the unknown or outside of my comfort zone. I suppose it won't always be like that, and maybe that's just what I need right now. But if you don't feel like you are getting confirmation you are moving in the right direction or are unhappy with an angle in your life, switch it up. Try a new approach or even a completely different path. Appropriate and calculated risks can be some of our most poignantly refining moments in life. Sometimes we take steps only to find that what was waiting beyond the bend is something completely different than we ever expected in the best of ways. I wish I would have left the safe harbor of routine and comfort years before, These types of moments brought me to Chicago, reignited my faith, bolstered my confidence, returned me to school, and re-charted my course of life in a direction I never would have seen coming in just four amazing years. Those are real life miracles. In two short weeks I am coming to another crossroads of life and couldn't be more excited to see what this next chapter holds. I know I'm in the groove and the path will be there even when I may not be able to see it clearly. The last written step on my vision board says "West Bound and Down" and after that it'll be time to build another game plan. Some of the pieces to move home are in place, but many more are not. I've largely been calling audibles for the last few weeks, but so far that's been working out just fine, and I plan to "Omaha" myself right through Nebraska back to a Mile High. See you soon Denver. Last night a patient stop breathing on us. Twice. I had 20 minutes left in my shift and just got back to the unit from transporting another patient to the floor to find Jena, one of the PACU nurses, with the Ambu bag over Mr. Code Blue's face. Ambu bags crudely but purposely channel oxygen to those in need. Think of it like a billow you pump with your hand attached to a mask over a person’s mouth and nose.
.The following is a play-by-play of everything that happened over the next hour, along with the mental score I was tallying for myself. To keep an honest score I have to rewind the story to roughly 20 minutes before I ran my transport. Jena was busy doing some charting standing over her patient. I was sitting at the nurse’s station in a chair watching her work and looking at her patient. I noticed the patient doing what seemed to be shivering or slightly shaking. Shivering and being cold after surgery in and of itself isn't abnormal. The operating rooms are cold and anesthesia, intravenous fluids, and open incisions can lower body temperature 2-4 degrees Fahrenheit. But for some reason, something didn't sit right with me or look right to me. I’m giving myself 1 point for noting the nursing spidey-sense that all was not well, and I’m going to award a bonus point because this was the first time I’ve ever had that sensation which was pretty cool. Unfortunately I lose these points right back to the house because a neglected to tell Jena what I saw or that I felt something wasn’t right. Alex: 0, Self-Doubt: 0 As soon as I got back to the unit and saw the Ambu bag in use, I obviously knew something was up, we don’t bust those out for a good time. The patient had de-satted while I was on my transport. This means that Mr. Blue’s blood was finding less and less oxygen to load and deliver to the rest of the body. The intensity in the room elevated a notch. Linda, the other PACU nurse working, was scrambling for some medication and yelling some instructions to me. She told me make a couple phone calls, one to the OR (operating rooms) informing them that we needed some help with their most recent delivery, and the other to the floor Mr. Blue had departed from for surgery to let them know their patient was not coming back. Jena had been getting him ready for transport while I had been away. Thank goodness this all didn’t go down on the transport! Alex: 2, Self-Doubt: 0 The anesthesiologist who had worked the procedure on our friend came to join the party. After a brief pow-wow, the conclusion was reached that the narcotics given to the patient had probably impacted his breathing. Narcotics slow the rate and depth of breathing which can lead to a respiratory depression where not enough gas exchange is taking place and carbon dioxide levels in the blood rise while oxygen levels decline. This is obviously not a good sign since we are not plants. Luckily Linda had already been keen to this train of thought and had been grabbing the proper anti-narcotic drugs while yelling at me to make some calls. The drugs worked and the patient began to rebound. We were joined by the intensivist and after another pow-wow, the conclusion was reached that the same thing would happen again as soon as the anti-narcotic drugs wore off. It was decided the best course of action was to intubate the patient and put him on a ventilator. The anesthesiologist left and came back with the intubation kit and called for a syringe. Jena asked me to grab it for the anesthesiologist and scurried off to do something I should have already been moving on. Luckily the anesthesiologist asked for another syringe and I got redemption to quickly grab another one for her. Alex: 1, Self-Doubt 1 While everyone was setting up to do the intubation I was watching the monitor and watched the patient begin to de-sat on us again, 95%, 90%, 85%, 80%,78%... For some reason I figured that because there was two doctors and two nurses present, I didn't need to say anything about our patient taking a nose dive south right in front of us. Fortunately the anesthesiologist looked at the monitor, “Oh Gosh, he’s de-satting!” By now we’d been joined by 2 respiratory therapists and they began to bag the patient again with the Ambu bag. Alex: 0, Self-Doubt 2 The anesthesiologist is ready to start intubating the patient. I brought the crash cart over just in case things decided to get even worse. The anesthesiologist wanted a CO2 monitor to attach to the airway, but we couldn't locate one in our supplies. Everyone thought there was one in the crash cart so I opened up the crash cart but we couldn’t find the CO2 monitor in the intubation drawer. I remembered that there was another crash cart on our unit so I busted into that one and pulled out the CO2 monitor they're looking for and handed off to the nurse. Unfortunately I didn't realize that our other crash cart was just for pediatrics, so now we have to crash carts that need to be reloaded. One of the respiratory therapists then chimes in that the CO2 monitor is in the miscellaneous drawer of the crash cart. One point for me making moves, but minus ½ a point for unknowingly trashing our PEDS crash cart. Minus 2 points to the respiratory therapist who could have helped us avoid that whole debacle. Alex: .5, Self-Doubt: 2 The anesthesiologist began the intubation. I immediately felt foolish because everybody was asking for things and I had no idea what they're asking for. The anesthesiologist wanted a wand to suction then she wanted the tubing which was right in front of me… Alex: .5, Self-Doubt: 3 In the end the patient was stabilized, intubated and placed on a ventilator, which is all that really matters. We had one other ICU patient on our unit who it turns out the respiratory therapists had come down to help me transport to the ICU. I began switching her over to a transport monitor and went with the two respiratory therapists to deliver the other patient to the ICU. It was a good transport. Everything went well and I felt very helpful, which is saying something. ICU transfers used to be overwhelming because there are a lot of lines and connections to the patient to keep an eye on and a lot of people working and helping with moving the patient from the cart to the bed. Sometimes it was hard to know where to jump in and help. Alex: 2.5, Self-Doubt: 3 I got back to the unit from the transport and honestly felt a little sheepish that I hadn't been able to do more with everything that had happened. Jena and Linda both told me thank you for all the help and Linda told me I was going to be a great nurse. But because I sometimes beat myself up, I wondered if she was being sarcastic. I felt like maybe I don’t have what it takes to be a great nurse or to work with critical care and trauma patients. Linda kept telling me to leave, because I had ended up being at work an extra hour when it was all said and done. As I scrubbed out and walked to my car I reflected on the shift. I realized I could get down on myself for everything I didn't do or look at everything I learned tonight and grow from there. I learned if I see something, say something (this logic is probably more effect in the hospital then on the CTA) and act even if you are the lowest person on the totem pole. I learned what a whole bunch of new equipment was. I learned what happens or what we do when a patient stops breathing. I learned how fast things can turn south for a patient. I learned we have a PEDS and an adult crash cart. I learned that my sharp eye for detail can be just as strong with patient care. Alex: 3, Self-Doubt: 1 There’s so much I don’t know, but I also am not even an RN much less an anesthetist. My co-workers tonight all have many years of experience on me, and they too probably felt like a bumbling fool at some point when they were green and cutting their teeth in this profession. The RNs on my unit often ask me about my school studies, and I’ve heard on more than one occasion that while school is great, you won’t remember or use much of what you learn in school. Medicine is a career that you have to learn by actively engaging in the work in addition to what you study and learn. I’ve always been blessed with the book smarts, and am grateful to walk through some knocks last night to be more prepared for whatever comes next. I’ll be ready. Folks, I’ve been called up to “The Bigs”!! I am excited (and extremely nervous) to tell you this Monday; I will be starting on the PACU unit at Advocate Christ Medical Center in Oak Lawn.
PACU stands for post anesthesia care unit and is the jump off where most post-op patients come after surgery. It is here that the nursing team monitors your return to earth from the murky clouds of sedation, making sure you gracefully and groggily land on your feet knowing who and where you are. My official job title is Patient Care and Information Associate, which is a fancy way of saying nursing assistant in hospital lingo. Like the patients I will help care for on the unit, I will be hoping to land on my feet sooner than later. I wish I could tell you that I feel like my clinical experiences at the nursing home earlier this year have adequately prepared me for this plunge into the unknown; but the reality is that I don’ think those weeks or anything else can truly prepare me for the door I’m about to walk through. How can you prepare for the fact that you may have to call a “Code Blue” upon finding a patient unresponsive or answer a call light for a patient taking a turn for the worst? It’s one thing to know how to perform CPR, but a whole ‘nother animal knowing the day is coming when that page of the playbook is going to be needed. That heaviness seemed so far off when I started down this path two years ago, heck that idea seemed far off three months ago training as a CNA, but it’s here now, and it’s very real. The difference is that in the nursing home, that knowledge was something nice to have, it was a just in case. In the hospital, it’s something I expect to use sooner than later and is a tool in the bag that has to be ready to go at a moments notice. My biggest fear is not acting soon enough in the heat of the moment or not picking up on signs of trouble early enough. I want to be an expert at saving lives, but don’t have any experience doing so. The only way really, is trial by fire, which sounds nuts saying that out loud because people’s lives will literally be on the line! With anxiousness of course comes excitement. This is what I’ve been working so hard for. This is a liminal moment in my journey and with any fears comes intense curiosity and passion. I know I am walking into a great unit and will have a team of dedicated people willing to answer the million questions I am sure to have. Next week I will be working with a preceptor each day as I learn the flow of the floor. The PACU unit will be an interesting unit to work on. My managers have told me we will see a little of everything from scheduled and routine outpatient surgeries to many emergency procedures. People will either stabilize from their surgeries and be discharged or stay overnight, or they will need to go to the ICU for further help and care. One of my primary responsibilities will be assisting with discharges and transporting patients to other areas of the hospital as needed including the ICU. Right now my position is what is called registry in the healthcare industry. This means that my schedule is not set and I may not be scheduled to work consistently. I am essentially there as needed and to support people on vacation and out sick. Some of you may wonder why I have taken a position that is an hour driving commute with unpredictable hours. As my good friend, the 2dollahalla, likes to paraphrase, “Sometimes you got to go out on limb, cuz that’s where the fruit is.” Let me tell you those are some words to live by. In some ways I feel like I am swimming in the deep end with no lifeguard on duty. My unemployment is about to run out and I am at a crossroads for deciding which way to head with work. But I’m not worried one bit. I’ve been carried along this far on my journey and it’s not over yet. The last two years I’ve been out on a limb with this plan, in fact, I landed on a limb of an idea and followed that branch down to find out there was a thick trunk of passion, focus, and desire below supporting the direction I wanted to head. It’s time to climb back up and see what that new fruit tastes like higher in the tree. My foot’s in the door at Advocate and my intentions are to push the rest of myself right on through. While the pay may not be great, I know the experience I will be stacking with be invaluable. When I get to nursing school next year and am on clinicals I will be a leg up on those around me. When my classmates are worrying about performing CPR or carrying out some other task or skill, I will be there to not only help them on their journeys, but reaffirm my confidence in my own. It’s hard to help others sometimes when you can’t help yourself first. Things had hit a lull in my journey over the last couple months, but I can assure you they are back in full swing with work and summer school. Stay tuned for more posts coming soon about life on a PACU and my nursing pursuits. Cheers. |
Alexander McNaChronicles of my journey into the nursing profession. Archives
September 2018
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