yes… guilty. it was me.
thank you for being as judgmental as me. it really is one of the strong points of our relationship.
I stumbled on this blog post written by a nurse, framed as a letter to the family of her ICU patient. I think it speaks well to the ups and downs that medical professionals, and ICU nurses in particular, go through daily. It also illustrates the tension between families and medical providers in the especially tense ICU setting.
The excerpt below is just the tip of the iceberg but sets the tone of the entire post.
Working in the Intensive Care Unit (ICU) is an experience that can’t quite be put into words. It’s fast-paced, intense, and the stress of some situations can even occasionally make my own heart rate go up as high as one of our trauma patients.
Some people love us. Some people hate us. I can promise you that you do not want to be a patient in my unit. If you are then that means you’re really sick. But I can also promise you that if you end up here you will get stellar care by a team of the best health care providers available.
Often times we may act a little wacky though. We may seem rude at times. Maybe you catch us acting totally inappropriate for the situation at hand. Maybe you’ve even thought, “how can they act that way with all this going on with my family member?”
Well, we have our reasons.
Last month’s ruling from a federal court in Utah certainly sent shockwaves throughout LGBT and conservative groups alike when the court decided that Utah’s ban on same-sex marriage was unconstitutional. While that case is currently under a temporary stay due to an order from the Supreme Court, another court in another highly conservative state is making waves… and this time it’s in Oklahoma.
A federal judge in Oklahoma ruled today that the state’s constitutional amendment barring same-sex marriage violates the federal Constitution. In his ruling, Judge Terence C. Kern of United States District Court for the Northern District of Oklahoma, in Tulsa stated that the ban is “an arbitrary, irrational exclusion of just one class of Oklahoma citizens from a governmental benefit.” The amendment, he said, is based on “moral disapproval” and does not advance the state’s asserted interests in promoting heterosexual marriage or the welfare of children.
The ruling will not immediately take effect, pending an appeal from the state, one that Oklahoma is almost guaranteed to pursue. Given the recent ruling in Utah, Judge Kern smartly stayed his decision in anticipation of an appeal by Oklahoma to the same appeals court where the Utah case is being heard, the United States Court of Appeals for the 10th Circuit in Denver.
Sometimes my friends are geniuses…
Expressing your feelings, especially affirming sentiments, should not be reserved for the space between your ears.
For the past few years, Facebook has allowed its users to construct a “Year in Review”, full of highlights from the past year – photos and status updates that received the most “likes” or comments from other users. To be honest, I just did mine today because to me, a year in a review truly cannot be done until the year is virtually over. But before I ran the year in review, I wondered what it would look like, what would be featured, and what I could gather from that review…
Indeed, the past year has been one full of changes and challenges, of fulfillment and turmoil, of triumphs and terror. It has been punctuated with tremendous highs – graduating with a Masters in Public Health, traveling to and operating in Haiti, becoming an uncle again, enjoying my relationship with my significant other and growing into a better person as a result. The year has had its share of lows as well – the uncertainty of returning to general surgery training, readjusting to a “work/life” balance upset by medicine, feeling rusty and inadequate as a physician and surgeon, grappling with a challenging personal issue involving my family, and grasping and coming to terms with the immeasurable loss of my grandmother.
I certainly would not have survived without the love of my dearest friends, a love that became all too clear after the terrifying events of the Boston Marathon bombing and ensuing lockdown. There are moments in life where you wish for your family to be close by, to hug and to hold your parents and to have them tell you that everything will be okay. Sadly, my family does not live near Boston, and in those horrifying moments after the bombing, it was my friends that I turned to for comfort, support, and camaraderie. They are the rocks on which I rely for strength, the shoulders to cry on, and the ears to talk to. It has been said that friends are the family we choose for ourselves, and I like to think I’ve chosen wisely.
So yes… I wondered what that “year in review” would reveal. And then… I remembered why I love New Year’s Eve so much to begin with, because New Year’s Eve is not meant to be a time to only rewind, regret, and wonder what could have been. Reflecting on the year that has gone is great but only as a stepping stone for the year ahead. For those who don’t like New Year’s Eve, those who get bogged down in the mad dash of the holiday season and the need to figure out what to do, New Year’s Eve isn’t about the best party plans or sitting alone wallowing in self-pity. New Year’s Eve is a gift we are given each year, an opportunity to change the bad, to put our fears, regrets and sorrows behind us, and to start over again with a clean slate. New Year’s Eve is the ultimate chance to look ahead, not backward. So take a moment to reflect and ponder, generate your “year in review” and remind yourself of all the good times. Then ask yourself not what could have been – but what should be done. And once you have your answer, raise your glass and toast to what will be.
Last year on New Years Eve, I posted a few of Marc and Angel’s 30 Things to Start Doing for Yourself. Since it’s the day after Christmas, and for most of us that means we have many new things in our life to be thankful and grateful for, I figured it would be a good time to take a look inside and think about the things we can change.
- Start spending time with the right people. – These are the people you enjoy, who love and appreciate you, and who encourage you to improve in healthy and exciting ways. They are the ones who make you feel more alive, and not only embrace who you are now, but also embrace and embody who you want to be, unconditionally.
- Start facing your problems head on. – It isn’t your problems that define you, but how you react to them and recover from them. Problems will not disappear unless you take action. Do what you can, when you can, and acknowledge what you’ve done. It’s all about taking baby steps in the right direction, inch by inch. These inches count, they add up to yards and miles in the long run.
- Start being honest with yourself about everything. – Be honest about what’s right, as well as what needs to be changed. Be honest about what you want to achieve and who you want to become. Be honest with every aspect of your life, always. Because you are the one person you can forever count on. Search your soul, for the truth, so that you truly know who you are. Once you do, you’ll have a better understanding of where you are now and how you got here, and you’ll be better equipped to identify where you want to go and how to get there. Read The Road Less Traveled.
- Start making your own happiness a priority. – Your needs matter. If you don’t value yourself, look out for yourself, and stick up for yourself, you’re sabotaging yourself. Remember, it IS possible to take care of your own needs while simultaneously caring for those around you. And once your needs are met, you will likely be far more capable of helping those who need you most.
- Start being yourself, genuinely and proudly. – Trying to be anyone else is a waste of the person you are. Be yourself. Embrace that individual inside you that has ideas, strengths and beauty like no one else. Be the person you know yourself to be – the best version of you – on your terms. Above all, be true to YOU, and if you cannot put your heart in it, take yourself out of it.
- Start noticing and living in the present. – Right now is a miracle. Right now is the only moment guaranteed to you. Right now is life. So stop thinking about how great things will be in the future. Stop dwelling on what did or didn’t happen in the past. Learn to be in the ‘here and now’ and experience life as it’s happening. Appreciate the world for the beauty that it holds, right now.
- Start valuing the lessons your mistakes teach you. – Mistakes are okay; they’re the stepping stones of progress. If you’re not failing from time to time, you’re not trying hard enough and you’re not learning. Take risks, stumble, fall, and then get up and try again. Appreciate that you are pushing yourself, learning, growing and improving. Significant achievements are almost invariably realized at the end of a long road of failures. One of the ‘mistakes’ you fear might just be the link to your greatest achievement yet.
- Start being more polite to yourself. – If you had a friend who spoke to you in the same way that you sometimes speak to yourself, how long would you allow that person to be your friend? The way you treat yourself sets the standard for others. You must love who you are or no one else will.
- Start enjoying the things you already have. – The problem with many of us is that we think we’ll be happy when we reach a certain level in life – a level we see others operating at – your boss with her corner office, that friend of a friend who owns a mansion on the beach, etc. Unfortunately, it takes awhile before you get there, and when you get there you’ll likely have a new destination in mind. You’ll end up spending your whole life working toward something new without ever stopping to enjoy the things you have now. So take a quiet moment every morning when you first awake to appreciate where you are and what you already have.
- Start creating your own happiness. – If you are waiting for someone else to make you happy, you’re missing out. Smile because you can. Choose happiness. Be the change you want to see in the world. Be happy with who you are now, and let your positivity inspire your journey into tomorrow. Happiness is often found when and where you decide to seek it. If you look for happiness within the opportunities you have, you will eventually find it. But if you constantly look for something else, unfortunately, you’ll find that too. Read Stumbling on Happiness.
- Start giving your ideas and dreams a chance. – In life, it’s rarely about getting a chance; it’s about taking a chance. You’ll never be 100% sure it will work, but you can always be 100% sure doing nothing won’t work. Most of the time you just have to go for it! And no matter how it turns out, it always ends up just the way it should be. Either you succeed or you learn something. Win-Win.
- Start believing that you’re ready for the next step. – You are ready! Think about it. You have everything you need right now to take the next small, realistic step forward. So embrace the opportunities that come your way, and accept the challenges – they’re gifts that will help you to grow.
- Start entering new relationships for the right reasons. – Enter new relationships with dependable, honest people who reflect the person you are and the person you want to be. Choose friends you are proud to know, people you admire, who show you love and respect – people who reciprocate your kindness and commitment. And pay attention to what people do, because a person’s actions are much more important than their words or how others represent them.
- Start giving new people you meet a chance. – It sounds harsh, but you cannot keep every friend you’ve ever made. People and priorities change. As some relationships fade others will grow. Appreciate the possibility of new relationships as you naturally let go of old ones that no longer work. Trust your judgment. Embrace new relationships, knowing that you are entering into unfamiliar territory. Be ready to learn, be ready for a challenge, and be ready to meet someone that might just change your life forever.
- Start competing against an earlier version of yourself. – Be inspired by others, appreciate others, learn from others, but know that competing against them is a waste of time. You are in competition with one person and one person only – yourself. You are competing to be the best you can be. Aim to break your own personal records.
- Start cheering for other people’s victories. – Start noticing what you like about others and tell them. Having an appreciation for how amazing the people around you are leads to good places – productive, fulfilling, peaceful places. So be happy for those who are making progress. Cheer for their victories. Be thankful for their blessings, openly. What goes around comes around, and sooner or later the people you’re cheering for will start cheering for you.
- Start looking for the silver lining in tough situations. – When things are hard, and you feel down, take a few deep breaths and look for the silver lining – the small glimmers of hope. Remind yourself that you can and will grow stronger from these hard times. And remain conscious of your blessings and victories – all the things in your life that are right. Focus on what you have, not on what you haven’t.
- Start forgiving yourself and others. – We’ve all been hurt by our own decisions and by others. And while the pain of these experiences is normal, sometimes it lingers for too long. We relive the pain over and over and have a hard time letting go. Forgiveness is the remedy. It doesn’t mean you’re erasing the past, or forgetting what happened. It means you’re letting go of the resentment and pain, and instead choosing to learn from the incident and move on with your life.
- Start helping those around you. – Care about people. Guide them if you know a better way. The more you help others, the more they will want to help you. Love and kindness begets love and kindness. And so on and so forth.
- Start listening to your own inner voice. – If it helps, discuss your ideas with those closest to you, but give yourself enough room to follow your own intuition. Be true to yourself. Say what you need to say. Do what you know in your heart is right.
- Start being attentive to your stress level and take short breaks. – Slow down. Breathe. Give yourself permission to pause, regroup and move forward with clarity and purpose. When you’re at your busiest, a brief recess can rejuvenate your mind and increase your productivity. These short breaks will help you regain your sanity and reflect on your recent actions so you can be sure they’re in line with your goals.
- Start noticing the beauty of small moments. – Instead of waiting for the big things to happen – marriage, kids, big promotion, winning the lottery – find happiness in the small things that happen every day. Little things like having a quiet cup of coffee in the early morning, or the delicious taste and smell of a homemade meal, or the pleasure of sharing something you enjoy with someone else, or holding hands with your partner. Noticing these small pleasures on a daily basis makes a big difference in the quality of your life.
- Start accepting things when they are less than perfect. – Remember, ‘perfect’ is the enemy of ‘good.’ One of the biggest challenges for people who want to improve themselves and improve the world is learning to accept things as they are. Sometimes it’s better to accept and appreciate the world as it is, and people as they are, rather than to trying to make everything and everyone conform to an impossible ideal. No, you shouldn’t accept a life of mediocrity, but learn to love and value things when they are less than perfect.
- Start working toward your goals every single day. – Remember, the journey of a thousand miles begins with one step. Whatever it is you dream about, start taking small, logical steps every day to make it happen. Get out there and DO something! The harder you work the luckier you will become. While many of us decide at some point during the course of our lives that we want to answer our calling, only an astute few of us actually work on it. By ‘working on it,’ I mean consistently devoting oneself to the end result. Read The 7 Habits of Highly Effective People.
- Start being more open about how you feel. – If you’re hurting, give yourself the necessary space and time to hurt, but be open about it. Talk to those closest to you. Tell them the truth about how you feel. Let them listen. The simple act of getting things off your chest and into the open is your first step toward feeling good again.
- Start taking full accountability for your own life. – Own your choices and mistakes, and be willing to take the necessary steps to improve upon them. Either you take accountability for your life or someone else will. And when they do, you’ll become a slave to their ideas and dreams instead of a pioneer of your own. You are the only one who can directly control the outcome of your life. And no, it won’t always be easy. Every person has a stack of obstacles in front of them. But you must take accountability for your situation and overcome these obstacles. Choosing not to is choosing a lifetime of mere existence.
- Start actively nurturing your most important relationships. – Bring real, honest joy into your life and the lives of those you love by simply telling them how much they mean to you on a regular basis. You can’t be everything to everyone, but you can be everything to a few people. Decide who these people are in your life and treat them like royalty. Remember, you don’t need a certain number of friends, just a number of friends you can be certain of.
- Start concentrating on the things you can control. – You can’t change everything, but you can always change something. Wasting your time, talent and emotional energy on things that are beyond your control is a recipe for frustration, misery and stagnation. Invest your energy in the things you can control, and act on them now.
- Start focusing on the possibility of positive outcomes. – The mind must believe it CAN do something before it is capable of actually doing it. The way to overcome negative thoughts and destructive emotions is to develop opposing, positive emotions that are stronger and more powerful. Listen to your self-talk and replace negative thoughts with positive ones. Regardless of how a situation seems, focus on what you DO WANT to happen, and then take the next positive step forward. No, you can’t control everything that happens to you, but you can control how you react to things. Everyone’s life has positive and negative aspects – whether or not you’re happy and successful in the long run depends greatly on which aspects you focus on. Read The How of Happiness.
- Start noticing how wealthy you are right now. – Henry David Thoreau once said, “Wealth is the ability to fully experience life.” Even when times are tough, it’s always important to keep things in perspective. You didn’t go to sleep hungry last night. You didn’t go to sleep outside. You had a choice of what clothes to wear this morning. You hardly broke a sweat today. You didn’t spend a minute in fear. You have access to clean drinking water. You have access to medical care. You have access to the Internet. You can read. Some might say you are incredibly wealthy, so remember to be grateful for all the things you do have.
I mean who hasn’t been that single girl (read: gay) surrounded by her best girlfriends (read: older, coupled gays) totally being slut shamed by them and telling you that you’re going to die alone if you don’t put yourself out there and find the right guy?
No? Just me? oh…
Proof that good things can come on Mondays as well, New Jersey joins 13 other states to affirm marriage equality today.
Despite Chris Christie’s best efforts to defy the New Jersey Legislature, earlier today the governor of New Jersey announced that the administration would drop it’s appeal of lower court judge’s ruling that current law in New Jersey violated federal law following the repeal of DOMA.
But let’s be honest – this was inevitable. Just look at the Great Seal of New Jersey… there are two women practically holding hands. :)
When I began my general surgery training five years ago as a lowly intern, it did not take long to meet “M”. M was one of the more senior registered nurses (RN) who worked the night shift on our surgical floor. On meeting M, I immediately liked this woman, and I knew that she would quickly became one of my favorite nurses. Tough and experienced, M is extremely smart and a better clinician than most interns, capable of picking up the slightest hint of something wrong with a patient before physicians would recognize anything was off. M is a “no nonsense” kind of nurse; she commanded respect when working the night shift and definitely did not put up with shenanigans from my fellow interns. She was particularly hard on other services that she felt didn’t “own” their patients as well as the general surgery residents do. But M also has an incredible sense of humor, and many nights during my night float month in February 2009 were spent laughing until our stomachs hurt.
After serving as a bedside nurse on a surgical floor for 25 years, M decided to make a career move. Our hospital is in the process of training nurses to gradually replace retiring operating room staff. M applied and much to her surprise was selected to be one of the new “intern” nurses. Leaving bedside nursing to jump head first into the world of the operating room can be daunting, inspiring, and incredibly rewarding – similar to what I remember experiencing as a surgical intern. M is beginning to chronicle her journey on her new blog, and so far I’m finding the nursing point of view of what I experience on a daily basis as a surgical resident to be absolutely fascinating. I can’t wait to actually work with her again in the operating room. Below is an excerpt from the first post on her blog; check out her journey if you like what you read.
The world of OR nursing takes a very special personality – a group that is not necessarily easy to break in to… who I am kidding… nurses tend to eat their young. This is a very sad, but very true statement. The fact of the matter is, if you cannot survive the stress of being a new nurse you won’t survive happily as an experienced nurse. The job never gets easier. You are put to the ultimate test on a daily basis. You need tough skin and to be able to think fast on your feet. Your decisions can be life altering to your patients. You will experience things no one outside the profession would ever believe. You will cry. You will question yourself daily. But, you will make a difference in every life you touch, in some way. You will be amazed and amused. You will learn to love cold coffee. You will develop a bladder the size of the Titanic. You may start swearing like a sailor. Your colleagues will become family. You learn to treasure life because you see so much tragedy… and you learn to celebrate the little things.
The intended and unintended consequences of labeling patients as “good” and “difficult”, from the eyes of a physician turned caretaker.
Although many physicians would have made different choices than I did, the impetus for my decisions lay in a trait of our medical culture. When we call patients and families “good,” or at least spare them the “difficult” label, we are noting and rewarding acquiescence. Too often, this “good” means you agree with me and you don’t bother me and you let me be in charge of what happens and when. Such a definition runs counter to what we know about truly good care as a collaborative process. From the history that so often generates the diagnosis to the treatment that is the basis of care or cure, active participation of patients and families is essential to optimal outcomes.
There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness. That we sometimes feel besieged or irritated by these advocates speaks to opportunities for improvement in both medical culture and the health care system. Culturally, we could benefit from a lens shift toward seeing more-vocal patients and families as actively engaged in their health care, presenting new, potentially important information, and expressing unmet care needs. At the systems level, we need to both count (using specially designated sections of the medical record) and reward (through diagnostic and billing codes) the time that providers spend talking to patients and families.
~Dr. Louise Aronson
A weekend with out of town friends…
I know that I’ve got resting b*tch face!
He’s cute, but he’s also a stage 5 clinger!
He had salmon. I don’t remember his face, but I remember the salmon.
I don’t know, I didn’t take ‘Queer Theory’. I’m queer enough, I didn’t need the theory!