therapy

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Therapy is not for everyone, although one could argue that it should be (especially for healthcare workers), particularly when you consider the statistics for Americans experiencing mental health struggles, including suicide (NAMI, 2023):

Fast Facts
1 in 5 U.S. adults experience mental illness each year
1 in 20 U.S. adults experience serious mental illness each year
1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
50% of all lifetime mental illness begins by age 14, and 75% by age 24
Suicide is the 2nd leading cause of death among people aged 10-14 

Many find it difficult to open up to a stranger (albeit a licensed professional) about our personal “stuff” (i.e., baggage/traumas/depression/anxiety/addiction/etc.); there is still a stigma attached, even now. I am not ashamed to admit that I have sought help from a therapist(s) at several low points in my life, and it has kept me grounded and open to discovering a basic level of understanding about why I self-sabotage and use avoidance to not address some of my issues… avoiding heavy, dark feelings seems like an instinctual form of self-preservation, does it not? But I do know that ignoring the problem, and hoping it will work itself out doesn’t really solve anything… it just delays healing, and moving forward from our pain.

I have yet to meet an adult that is over the age of 30 who hasn’t experienced some degree of a mental health issue, including depression and grief from experiencing a traumatic loss (death of a spouse/friend/child/parent/loss of marriage/job/home/etc.). Pain and loss go hand-in-hand… and as complicated as life can be, it “moves on”, as it should. I clearly remember a simple life lesson that I learned as a child, from another child… I remember feeling very sad about having to move, and my friend said to me… “yes, this is sad, but it’s not the end of the world; the world is still revolving”. While I didn’t fully appreciate the reasoning or reality check at the time, I will never forget the lesson that it taught me: life is hard, and it can be both sad and wonderful, but it goes on, with or without you.

So we try to be resilient and take one day at a time with the hope that things will get better eventually, but the indefinite length of time that defines “eventually” can be so elusive. While it seems that exploring a pathway past pain requires being hopeful and brave, each time it gets harder and harder to stay optimistic. Nothing kills hope faster than disappointment, and showing any degree of courage over fear has its consequences… embarrassment, shame, regret… all the greatest hits.

But my point is this… therapy helps. It heals, and it is sometimes the only thing that gives hope a shot in the dark.

Reference:

National Alliance on Mental Illness. (2023). Mental health by the numbers. Retrieved from https://www.nami.org/mhstats

be your own friend (byof)

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When I find that I am feeling really bad about something that I said or did (or didn’t do), I try to think about what would I say to a friend who was telling me the same thing. I know that I would definitely be kind(er) and gentle(r) than I am being to my own self. I would try to be a good friend, and I would try to help them to forgive (themselves) for being human and imperfect… and wouldn’t it be great if we were all better friends to our own selves? It’s easier said than done (I know) to just “let it go” and clear our minds from the stream of negative thoughts, but I think that it’s really important to try to remember to do that before we start to believe all the mean stuff that we sometimes say to ourselves, like “I am such a dumbass…how the heck did I forget to do that… what’s wrong with me… I’m so stupid…I’m such a #@&%-ing idiot, etc.”. We can be our own worst enemy. Showing yourself some grace is a much healthier alternative than berating ourselves with self-deprecating thoughts. Isn’t life hard enough without adding to the pain and stress?

Truth.

I am, as ever…

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Rejection, in any form, can break your heart. Whether it is done in a kind and sensitive way, that is intended to deflect blame, or in a way that seems to be dismissive, and only serves to patronize, or diminish one’s feelings…hurts. like. hell.

After so many years of hiding behind a protective wall, peeking out from the light-filtering curtains now and then, and testing the waters by dipping your toes in, to see if the temperature feels “comfortable”, gives a false sense of bravery… and then you take a deep breath and decide to “go for it”… only to be shut down, without a second thought. Oh yeah, that feels familiar, and you remember why you built up that wall in the first place…and you cry yourself to sleep, admonishing your actions, and promising to do better, be better, look better. Yeah, that sucks.

I’ve written about being vulnerable before, and putting yourself “out there” by feeling strong, and finding courage in a universe that is disguised as “fate”, but that is really hard to do. I can’t fathom having to do this all over again. I’m not as strong as I used to be… nor am I as weak as I have been. I have no one else to blame but myself, really. Making choices based on what feels “right” or “right at the time” has always been my own “Mt. Everest” that has yet to be conquered.

I know what I don’t want… and what I want has been oh, so elusive. At some point, I have to wonder if I should even try… I mean, the odds are against me, especially at my age. There is something comfortable in being alone… there is no heartache without some kind of rejection. It only hurts when you try, and fail.

Nurses fix things, don’t they? They are the constant during the worst times, who use everything that they have in their “comfort care” fanny pack to lessen the pain and make the hard things… bearable. But what if the pain is in their own heart and mind? Who fixes that? Asking for a friend…

I am, as ever.

Life of Joys and Sorrows

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Life is funny, isn’t it? I don’t mean “funny haha”, I mean that life is a self-propelled roller-coaster ride of both joy and sorrow. All of us have unique burdens and “stuff” that we carry, but everyone experiences both joy and sorrow throughout their lives. How we manage these experiences can define our existence, and help us choose our next path (for better or worse).

Joy and sorrow are proof of life. We tend to obsess over past mistakes with that gut-wrenching emotion called regret, or we worry so much about the future (what we want/don’t want to happen, as if we had complete control over that! Ha!), that we forget to stay present in the moment, and enjoy the little things that are happening right before our eyes. Or maybe that’s just me? Either way, I subscribe to the belief that “without pain, there can be no pleasure; without sadness, there can be no happiness; without these, life is endless, hopeless, doomed, and damned” (Ellison, 1999).

If you follow me on social media, you know that our current state of affairs is far from funny. Our political climate is basically a ticking time-bomb, and the tilted Supreme Court proved that they want to combine church and state, travel back in time, and challenge basic human rights that have been in effect for years. Women’s rights, in particular, are being targeted by some backward States, including the right to choose, right to contraception, and privacy; other “rights”, such as gay and interracial marriage, may be on the docket next. Don’t even get me started on the corrupt dynamic duo of Clarence and Ginni Thomas, who actively tried to overturn American democracy … but that’s another post for another day!

In nursing, we (intentionally or unintentionally) practice a therapeutic technique that incites laughter at the craziest things, which are usually quite serious, but occasionally, are seriously hilarious. Rationale being, it is better to laugh, than to cry. “Life has sadness and tragedy in abundance, but at the same time, it is pretty funny … humor can bring joy and reduce suffering” (Brooks, 2021). According to Sabato (2019), the use of levity can come from having a degree of distance from the immediate situation. I think this is something that healthcare providers aim to achieve when they are caring for their patients, especially during emergent medical situations. We have to be somewhat detached so that we can focus on the task at hand.

Sabato (2019) states that humor is tragedy plus time, and when we recollect serious misfortunes we have experienced, we can find some parts become more amusing as time passes. I believe this to be true. I have reflected on some painful memories in my life, and looking back, when I recount one of those stories, I am now able to make a joke about how great I am at making major life decisions (usually my pathetically endearing attempt at sarcasm and self-depreciation).

I started this blog 5 years ago (August 17, 2017 to be exact), because I had just taken a leave of absence from my job in NYC to help care for my Dad, who was transitioned by his Oncologist into Hospice care. It was a way for me to process my feelings of sadness, and very soon after, (August 26, 2017), grief. My joy and sorrow are experienced almost simultaneously because my Dad always kept his sense of humor, even as he experienced pain and a dismal fate. He made jokes about his plot in the cemetery being so close to the road so that when I visited him, I could just wave and not have to get out of the car. When asked how he was doing/feeling, he would immediately respond “fine and dandy”, or that he’s “still alive”. I know he did this not just for my benefit, but because he was still processing his own end of life. Brooks (2021) writes that “humor has an almost anesthetic quality to it, lowering the focus on pain, and allowing us to remember the joys in life”.

Life is funny, isn’t it? My advice is to always look up.

always look up

References:

Brooks, A.C. (2021). The link between happiness and a sense of humor. Retrieved from https://www.theatlantic.com/family/archive/2021/08/humor-happiness/619704/

Ellerson, H. (1999). Paingod and other delusions. E-reads.com

Sabato, G. (2019). What’s so funny? The science of why we laugh. Retrieved from https://www.scientificamerican.com/article/whats-so-funny-the-science-of-why-we-laugh/

Don’t Shoot!

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Another day in America = another mass shooting. How did we get here, and how do we stop the insanity?

I pray that we never become numb to these tragedies, I really do. The people that we elect to be in charge of protecting us, especially our children, are not doing a very good job, and they need to do better! This is quite literally a matter of life and death. It should be simpler than this. It should never be easier to legally purchase a weapon(s) and hundreds of rounds of ammunition, than it is to get a driver’s license, or buy a six-pack of beer! Period. Hard stop! But alas, nothing is easy (or rational) when it comes to a divided America.

“A house divided against itself cannot stand” (Abraham Lincoln, June 16, 1858). It has been over 164 years (almost to the exact day!) since Lincoln gave his famous speech, and yet we seem to have learned nothing. Shame on us.

Why are there so many obstacles blocking (safe) restrictions to purchase firearms… why? Why does an 18 year old (boy) need an AR-15 rifle… most likely, it is not out of good intentions. And if you really want to use weapons of war, for the love of God, do us all a favor and join the U.S. Military and learn about responsibility, courage, and honor. And, while we are at it, can someone please tell me why some (mostly men with white-privilege), think that it’s perfectly acceptable/necessary to go into a WaWa for a cup of coffee and a Snickers bar, wearing military gear, as if they are in the midst of a suburban, small-town war, just because they can (insert eye roll)? Are they making a bold (and idiotic) political statement about their 2nd Amendment Rights? These typically “pro-lifers” don’t seem to care about ALL lives, do they?

I use my words (and my 1st Amendment Right) on social media because I don’t know what else to do. I won’t be silenced, despite pissing off (and alienating) a few people along the way. None of us can, or should, (just) get used to these daily tragedies. If you have not been directly affected by gun violence, count yourself as lucky… but that luck may run out, and when that happens, and it WILL happen if things continue along this path, how will you feel? Your gun rights are not more important than the right for all of us to go to school/church/market/concert/movie… and be safe.

Laws prohibit those who have not passed a written test, received a learner’s permit, and then, we must still pass a practical driving test to get a Driver’s License, because a vehicle is also a weapon that kills. So why would gun laws not require the same type of training and testing?

Lately, I have been wondering if I will be next. I am not a person who is easily frightened. I’m a nurse for God’s sake (and we have seen A LOT!), but nothing seems sacred or safe anymore. Churches are supposed to be sanctuaries where we go to pray and feel closer to God, but that is just not the case, despite our 1st Amendment Right!

The world has been getting scarier, and many of our “Leaders” don’t seem to care; they pad their pockets with money from the NRA, while turning a blind eye to the violence. That’s the deal that they make with the devil; they sell their soul, and look to others for blame because it’s easier than looking at themselves in the mirror. It makes me so angry, and I feel helpless. That is the hard part of being in such a vulnerable position. And let me be clear, we are all vulnerable! If you think owning a gun makes you less vulnerable, you are wrong, because even if that person with mental health issues doesn’t go after you in the WaWa, they may go after someone that you love… like your child while he/she/they are in school, just being a kid and trying to learn to read, or understand Algebra.

Yes, we have a lot going on in our country right now, with inflation and gas prices soaring; the stock market is very concerning too, of course. Republicans and Democrats do not agree on much, but we are ALL equally affected by what is happening around us, and yes, things seem bleak at the moment. There seems to be two polar opposite extremes who look at the same issue, and see something entirely different. Where is the middle ground that can pass through the fluid purple-ish middle line of compromise? To quote the great journalist, Dan Rather (2022), “It doesn’t matter if the causes … are global and complicated; the party in the White House usually takes the blame, regardless of which party it is“. This is not the time to point fingers and block laws from being passed because one party doesn’t want the other party to succeed! That is so selfish, and so very stupid. It is also such a spiteful way to run the county. I firmly believe that we will get through this period; I don’t know when, but I do know that we all need to be mutually invested in what is “right” and best for not only our country, but also, and more importantly, our families.

So please, when you use your 15th, 19th, 24th, and 26th Amendment Rights to go out and vote, look at your choice of electives, and find out what they stand for before you give them your vote and your trust. Don’t put someone in the position to make decisions (on your behalf), that could endanger you or your family, because of their own financial agenda.

Who can tell the “good guys” from the “bad guys” anymore?

Reference:

Rather, D. (2022). Guns, Abortion, and the American Flag. Retrieved from https://steady.substack.com/p/guns-abortion-and-the-american-flag?r=du1sl&s=w&utm_campaign=post&utm_medium=web&fbclid=IwAR3bIUptVXeAlNXzNwPZ

Just Culture and human error

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If you’ve watched the News lately, you know that there is a (former) nurse in Nashville, Tennessee who was found guilty of negligent homicide due to a fatal medication error that killed a 75 year old man. For those of you that are not familiar with the medications cited for causing the error, she gave Vecuronium (a paralyzing agent used to chemically “paralyze” a patient, often given for a need to intubate someone, or to keep them from not moving as a skeletal muscle relaxer); Versed is a sedative. Other than starting with the letter “V”, they should never be confused. Never. Ever. Both of these are high-alert medications that should require a 2 RN verification process prior to administration. Vecuronium, in fact, is most often only administered by a physician, usually an anesthesiologist or nurse anesthetist. What this nurse was thinking when she pulled it out of the Pyxis, and confused it with Versed, one can only guess. Safety processes that are implemented to prevent errors like this from occurring, were ignored (and overridden), and as a result, tragically, a man died. I am sure that it is something that she profoundly regrets, and will never forgive herself (for). My heart really does sympathize with her.

Clearly she made a huge, unsafe error that cost her (her) professional nursing license, but should she go to jail as a criminal, is the controversial question? Some of my friends and colleagues have very strong feelings and opinions on both sides of that final judgement. Mine lies somewhere in between, as it often does when you deeply understand the root cause of what could have caused the event, because as a nurse, I know that accidents/mistakes/errors often happen due to a bigger picture of organizations failing to maintain safety protocols. While I do not know the entire story of what happened that day to make this nurse choose this medication, my understanding is that the “system” in which this nurse practiced failed her, and they too, are at fault.

A “Just” culture considers errors an opportunity for learning, to improve outcomes and performance, as part of their Quality Improvement measures; they acknowledge that errors happen due to faulty organizational cultures, rather than placing blame, or initiating punitive measures, solely on one individual (Wikipedia, 2022). Supporting the Just Culture approach to promoting safety and quality in healthcare means to seek out why an error occurred, rather than pointing fingers (or throwing someone under the bus as a scapegoat), by identifying “how” it happened, to improve practice, and prevent it from happening again (Boysen, 2013). Nevertheless, having a Just Culture cannot be a blame-free environment that does not demand accountability for errors. Was this a properly trained, competent nurse? I cannot say, but from what I have heard, she was transparent with admitting the error, and said that she was “distracted” and “complacent” (Kelman, 2022). As nurses, we can never allow ourselves to practice in such a mindset; we will always set ourselves up for errors.

References:

Boysen, P.G. (2013). Just culture: a foundation for balanced accountability and patient safety. The Ochsner Journal. Retrieved from https://ncbi.nlm.nih.gov

Kelman, B. (2022). Former nurse found guilty of accidental death of a 75-year-old patient. Retrieved from https://npr.org

Wikipedia. (2022). Just culture. Retrieved from https://en.m.wikipedia.org

Anxiety

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Experiencing anxiety is scary. I’ve rarely had feelings of being so restless or nervous that my heart could actually explode in my chest, but I have been feeling anxious a lot lately, and it is unsettling. I don’t know if it’s because I have had so many changes this past year, or the culmination of the last few years, but here I am… going through “stuff” that makes me feel very uncomfortable.

I also know that I have been feeling anxious for the brave and resilient people of Ukraine as a result of this horrific invasion by Russia… watching these families be separated, with women, children, and the elderly fleeing from their beloved country, to escape to Poland without knowing anyone there, or how they will survive, and having to say good-bye to their husbands/fathers, who must stay to defend their country… it is devastating, and it is hard to watch. But it is hard not to watch also. We are all brothers and sisters on this Earth, and the human connection can be just as strong as if we, too, were Ukrainian. It is the “what ifs…” that can be hard to think about as we try to predict the outcome of this pure evil and devastating act of aggression from a madman.

Part of my coping mechanism to process and manage my many thoughts is to write them down, so I will try to focus on things that I can actually control.

Some things that I have found helpful when I am feeling anxious.

I recognize that part of my anxiety is because I am at a crossroads with my job, and feeling alone and isolated. Life is too short to spend in a job that you do not love doing. You cannot just “go through the motions” when you work in healthcare, you just can’t. You won’t be successful, and even more importantly, you won’t be happy. I’ve been debating about the pros and cons of “staying in my lane” when it comes to career choices, and it has been a frustrating thing for me because I have always advocated for nurses to expand their horizons and see what opportunities come up that can challenge them in new ways. Change is good, yes? But what if it’s not? What if you choose a path that doesn’t feel right and doesn’t really “fit” who you are, or who you want to be… at the age of 55, where I am closer to the ultimate goal of a comfortable retirement.

I LOVE nursing. I love the feeling of being of service to others, and feeling like I am successfully fulfilling my God-given purpose. I also love working with nurses; standing beside them, and helping in any capacity that I can. I know that a job does not define who I am, but my career, and my passion for nursing DOES define me. I have spent more than half of my life being a nurse, and it has always “filled my cup” with a lifetime of fulfilling and rewarding memories.

I always thought that working from home was the ultimate “work place”; while I do love being in my new home, with my two “golden girls” (my faithful furry companions, Sammie & Gracie), it can also be very isolating, and that does not help my anxiety. It is hard enough to learn a new role when you are in an unfamiliar environment, but it is even harder to do virtually. I don’t run away from a challenge, or things that are hard… God only knows that I have had hard times and struggles in my life… but I think that may be the problem. I don’t like to (just) give up. While I do have hope that some things with my job are improving, but in reality, the things that I, personally, struggle with (like actually feeling confident, competent, and valued for my opinions, experiences, and instincts), will most likely, not.

This is easier said, than done.

I had a bad day…

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Some days are just too damn hard. It always makes me question “how the hell did I get myself into this mess… I should know how to avoid conflict by now”. I really do try to not take these things personally. I understand that it’s not about me … it’s usually about things that are way beyond my control… and isn’t “control”, or loss of it, the problem? Loss of control makes people angry… sometimes really angry… and (some) people can lash out against whomever they see standing in their way of what they want, or need. I know this to be true, but it still sucks to be at the receiving end of misplaced anger and aggression. In a world where many of us are trying to lay low, and avoid people who could potentially “turn” dangerous, it’s important to know when to ask for help from our employers to support us, and ensure that we are not being mistreated by those whom we are (only) trying to help.

It is so hard to work in healthcare, especially now during the extended period of Covid and its multiple variants. Most of us are working short-staffed, and many nurses are quitting the profession entirely. I know nurses who read my blog are all too familiar with the struggle, but for those who need to hear this… you can’t control what people say, do, think, or believe, you can only control how you respond to it. That’s it. So while I try to “shake it off” so I don’t lose sleep over what I should have said… I will know in my heart that I am not the only one having a bad day too.

Yes, it is my pleasure to recommend you for this job!

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Never underestimate the importance of experiencing the best and worst days in your nursing career with friends and colleagues who have walked those long hospital hallways right beside you. I always knew the reason behind my success, and decision to keep showing up when things got hard, was because of the special bond that we all shared with one another. Yes, it is always about our patients, but it is also about not dropping the ball when our team needs us.

I think this is what I miss the most. I miss the camaraderie and the connections. I miss feeling like I am a small part of a much bigger picture. I miss laughing when the only other emotional choice would be to cry. I yearn for the days where I wouldn’t have to look more than a few feet away for a friendly face who was willing to share a not-so-fun task with me, if for nothing else than moral support or a witness! I miss those days, but I will never forget them for as long as I live.

I often get asked to provide professional recommendations for many of the nurses that I have worked with in past roles as either a peer or manager. I see it as an honor that I am entrusted with this important step in creating new and exciting career opportunities for the people who continue to challenge themselves to learn and grow, for only change can provide new perspectives and ideas to help us to think and practice in a different way from what we already know. Today, as I completed one of those professional references for an old friend, I thoughtfully considered the last question, “What are the top 3 strengths of this candidate?”. All I could think of is “where do I begin…”. As a nurse who showed up to care for the sickest of the sick in 2020, in NYC, during the earliest, scariest, and deadliest time of Covid, the “strengths of a nurse” have new definitions, like courage and bravery, selflessness, and unparallelled dedication to her (or his) patients. In a time when the future was not certain, and science became so unpredictable, even deadly, showing up day after day, is really all that needs to be said. That’s the nurse who I want working beside me, whether we are in a pandemic or not!

Remembering my purpose

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I was just honored with an award for my blog. I never expected it, and it was a joyful surprise, and I haven’t had many of those lately. It’s never been a competition for me. It’s just been me, sitting at my laptop, and writing what is in my heart. Less of an ambition, than it was a form of self-expression. I prefer my words in the written format, because I am less astute at the speaking part of interactive communication. This recognition was a gift I think that I needed right now, with feeling somewhat uninspired as of late. So I am grateful for the kind words. It made me very happy and proud.

Being a nurse has been the one thing that I have been really good at; it’s how I define myself, even now. But I was having lunch with friends recently (all nurses) and we started talking about our most memorable experiences and patients… and we had some serious belly laughs… and some painful memories came up as well. It made me remember something that I heard that goes a little like this… “you pay for good days by having bad days, you pay for joy with pain”. And it was then that I realized that I almost forgot “her” name. I remember everything about her, from the day of her cancer diagnosis, to her last day on this earth in the PICU many years ago. As fate would have it, I was there for both. But I never want to forget her name. She was important and she was memorable… and she made a difference to all whom she met in her too-short life. She has always been one of my “reasons” for being proud of what I do for a living.

I have the heart of an empath; I can feel sadness and pain, and it makes me feel the same. I can feel joy and lightness, and it makes me feel alive. I am the happiest when I feel like I am doing something to help others, so when I feel like I am in a rut, I feel useless. And that is not a great feeling.

I currently work as a nurse for an insurance company; it’s a good job and I get to mostly work from home, which is a huge part of why I made this career choice. But as a nurse, it’s never been about insurance…never. Insurance is boring, let’s face it. Being a nurse is far from that. I can tell you that we never even considered it in our practice. That’s not to say that it wasn’t an “issue” in the medical management of our patients, just not “our” issue. I believe that we all deserve the same level of great care. Period. Hard stop.

That’s why it’s so hard for me to understand when my “members” (my pediatric patients) don’t get approved for important procedures/testing/consults with specialists that are out-of-network, etc., that could help with diagnosing, or managing, complicated medical and behavioral problems. I come from a place that always wants to help; to fix what is broken, but I can’t do that now. It’s not the way that this job works. But they try, and I try. And that’s important too. I guess I just need to remember my purpose in all that I do, whether I can see the outcome of that, or not.