I once read social media described as an indulgence of the fantasy that others are interested in the details of our lives. I’m indulging in that fantasy this week by blogging about my Mecation under the guise of travel blogging ;)
If you follow me in even the most casual way, you know I’m a nurse. While I’ve enjoyed the vast majority of my 23 years as such, I don’t recommend it during a pandemic. The last 18 months have been the second-worst mental health period of my life, demoted to that position not because of the mildness of my symptoms but simply because at 15 I didn’t have the experience or perspective to realize my life was not, in fact, ruined forever.
COVID increased my personal vulnerability as a high-risk patient and made my job immensely more difficult in countless ways both small and large, but the worst part of the pandemic for me (so far) is it took away all my coping mechanisms precisely when I needed them most. Massage, pedicures, dinner out with friends, travel ... all gone practically overnight. Pre-COVID I travelled all the time--home to my parents’, long weekends by myself (Mecation!), annual visits to BFFs, conferences, tourism, the beach, my birthday, writing trips, international trips ... I always had at least one trip in the works, usually one booked and one (or more!) in the planning stages.
When COVID started, all my close friends and family except for two lived out of state. One of those two was out of town but close enough to get together, but the other was a few hours’ drive away. I’m single and live alone; it was the most isolated I’ve ever been in my whole life.
With my bestest friends over 500 miles away, I still feel that way sometimes. I haven’t seen them in a year. If it weren’t for COVID, it would only be 7 or 8 months (I’ve gone every January or February since ... forever). Then again, if it weren’t for COVID, I wouldn’t have been there last September; one had been hospitalized and I needed to see she was all right with my own two eyeballs. I expect it will be at least another 7 or 8 months before we get together again, bringing the total to about 20 months. One year we saw each other 5 times in 9 months, our personal best since college.
I was alone on Christmas. Oh, I’ve spent December 25th on my own before; I’m a nurse. I’ve worked the night of the 24th or the 25th (or both), or whatever combination that didn’t leave enough time off to drive home. But I’ve never spent the Christmas season without my parents. Sometimes the week before, sometimes the week after, sometimes at my place instead of home, but always together. But last Christmas COVID was raging, the vaccines had just come out but were only available to first responders (I got mine on the 23rd), and my elderly parents didn’t feel safe to travel. So I spent Christmas without family.
Travel was not just a break from my daily routine and the stress of nursing; in many ways, the biggest benefit travel made to my mental and emotional health was giving me something to look forward to. Proverbs 13:12 says, “Hope deferred makes the heart sick,” and ohhh, I was so heartsick last year! Not being able to travel meant I couldn’t visit my best friends of almost 25 years (more than half my life!). Not being able to travel meant I couldn’t lean on my dad or be hugged by my mom. Not being able to travel--and not knowing when I could travel--left this gaping hole in my future, and I had nothing to fill it with.
I tell you this not to throw a pity party but to explain the significance of the trip I’m on right now. It is only my third this year: my dad and I spent a week in the mountains in February (my depression and anxiety was so bad then that was treatment, not vacation), I took a friend to the beach over my birthday, and now I’m a couple hours from home at a nice spa hotel. (I’m not counting my nephew’s graduation, which was emotionally challenging for multiple reasons, or helping a friend move from Florida. Moving is never fun.)
I started planning this trip in the spring ... May, maybe? You know, after the vaccine rolled out to everyone and case counts were dropping and it looked like we were gonna lick this thing and have a quasi-normal summer by the Fourth of July (yes, I’m American. That date is a proper noun here.). I had switched jobs in November (don’t ask) and gone on mental health leave December 29th, so I felt I owed it to my unit to put in about six months of work before taking any significant time off, especially since I came back at 24 hours instead of 36. That meant September.
I knew what I wanted to do: 4 or 5 days at an all-inclusive resort in the Caribbean. I’d been before and loved the freedom of not worrying about every little expenditure (what can I say, I’m cheap), and a few days of Vitamin Sea sounded perfect.
Then came Delta.
All right, maybe going out of the country isn’t the best idea, I thought. Don’t want to end up with expensive reservations and then your destination closes to Americans, or you make it to your chosen island but can’t get back home. But I didn’t want to fly (ugh, airports!), I didn’t want to drive (rest stops and restaurants and gas stations), and while I thought about taking the train, it didn’t seem much of an improvement (and maybe a downgrade) on flying.
Then a friend mentioned a sleeper car, and I thought yes! That could work! I’ve never been to New England, I want to go to Boston, that area of the country has low case rates and the highest vaccination rates, this has potential!
Then I looked at the CDC map. There were only four states that didn’t have high transmission at that time (early August, I think; I’d had to wait for confirmation that my time off had been approved): Michigan, Rhode Island, Maine, and New Hampshire. All four had substantial rates of transmission. Hardly ideal, but one thing I’ve learned this year is sometimes you have to make compromises to protect your mental health. It is true it doesn’t matter if you’re happy if you’re dead; it is also true it doesn’t matter if you’re safe if you want to kill yourself. (I’m not suicidal, I am receiving treatment, don’t anybody panic.)
So, now I’ve settled on Maine or New Hampshire by train via sleeper car (Michigan is too far for a 4-5 day trip and RI--meh). Well, as I got deeper into planning, turned out Maine or NH were awfully far too. Far enough I would have to overnight in a major city, which pretty much defeated the purpose of isolating in a sleeper car. Then I found out there were no sleeper cars on either train route.
So, now vacation is 5 weeks away and I’m back at square one. The Deep South, Texas, and Florida are imploding. Pediatric cases are rising--kids are sicker and make up a higher percentage of cases than they did last year. Scuttlebutt from my ICU colleagues is it’s bad--17/30 MICU beds are COVID and they’re all vented. SICU is being nicknamed “the ECMO unit.” The hospital has 18(!) ECMO machines and 12 are in use; the float nurse who tells us that didn’t even know we had 12 because she’s never seen that many in use at one time. Hospital-wide our numbers are equivalent to early February (we peaked in January). There were six--SIX--pediatric rapid responses in one day.
And I’m going to travel.
It’s a big deal ... a big accomplishment, really, because of what it says about how I’m successfully managing my anxiety. April 1 was the first time I’d been inside a grocery store in more than a year ... and that wasn’t my idea. It was late April or May before I was comfortable eating in restaurants, even with the falling case count at the time. I’m still not sure if I’m managing my anxiety or reacting to the pressure by going to the opposite extreme (I have a history of that), but I know I’m less stressed, less anxious, have fewer obsessive thoughts, fewer physical symptoms, and am learning to live with this disease.
So, here I sit at a marble-topped 5-foot-wide desk in my queen/queen hotel room at the end of a productive and enjoyable day. I slept in, completed the big goal of this weekend’s to-do list that I honestly thought would take several days, unpacked and organized my room (I arrived yesterday evening), reorganized my Favorites Bar and Bookmarks on my Mac, had an 80-minute aromatherapy massage, enjoyed a shower in the spa afterwards and even blow-dried my hair(!) before wandering around for a while to get the lay of the land and get some steps in (this place is huge!). Then I changed clothes and took myself out to dinner for my favorite food, Italian.
That’s me in the picture up top, all dressed up :) Actually, I probably look pretty normal to y’all; like most people with depression, my personal hygiene sunk to new lows in the last year and a half, and as a low-maintenance person to begin with, that’s saying a lot. I bought that necklace as a bridesmaid and am not sure I’ve worn it since; this spring was her 10th anniversary. Yesterday I took out the cat-shaped earrings Dad gave me for Christmas. (Yes, they were gross. Yes, I cleaned them. Yes, I’m wearing them again now.) Just wearing a nice top, fixing my hair (no ponytail or claw-clip bun, my staples), and adding jewelry was a big deal ... especially since “no one” was going to see me. I did it just for me, to make myself feel good. And I did. (That’s another small pleasure COVID took away from me--lip gloss. If I wore any makeup at all, it was lipstick or gloss. Utterly pointless when you’re masked whenever you’re in public.)
I took my laptop to dinner and edited a couple chapters of my new Charlie/Amy fic (previewed during #ktoo turns 10), ran a couple errands, and headed back to the hotel since I don’t like to be out late by myself in an unfamiliar city. Forgot I put my receipt envelope in the backseat pocket and reorganized the glove compartment looking for it, then gathered a bunch of returns into a bag in the trunk. Hung out writing in the lobby until my Mac threatened to die, came upstairs and tidied up, put on my jammies, and talked to you guys :)
This week marks the anniversary of the first COVID-positive patient in [state]. Today, we are hopeful as the inpatient count dropped below 30 for the first time since early November and the number of COVID-related absences is down to 14 (from an average of 70 per day).
my nurse manager
Y’all, this was in Friday’s weekly email update, and I CANNOT DESCRIBE MY EXCITEMENT. Like, Sherlock season 5 excitement! It’s stupendous.
I won’t go into the nitty-gritty of how we managed a 103% census (93-94%, which we would see pre-pandemic, is enough to make everybody want to pull their hair out and nearly grind the hospital to a halt), but suffice it to say ... it was gritty. The idea of being able to just do my job without all the “extra” that came along with COVID is a dream. Having said that--
WEAR a mask, WASH your hands, WAIT six feet apart whenever you’re in public. EVEN IF YOU’RE VACCINATED.
A Brief Summary of My Week or How I Lost My Status as Second-Floor Gin Rummy Champion
I work four 10-hour shifts in the PACU at a 80-ish bed community hospital.
Tuesday: Pt comes out from the OR on a T-piece. Pt remains intubated for approx 45 minutes (this is a REALLY. LONG. TIME). CRNA chats with anesthesiologist while I assess, intervene, and chart so the (inexperienced) anesthesiologist doesn’t Narcan a post-op--(I remember the bay the patient was in. I remember the anesthesiologist’s and CRNA’s first and last names. I remember what time we extubated the patient (1814), his pH, pCO2, end-tidal CO2 at the end of the case, and when the MD drew the ABG. I cannot for the life of me remember whether the patient was male or female or what surgery s/he had)--so he doesn’t Narcan an immediately postop patient and reverse all his pain control.
(This was after surgery yelled at me for doing a urogyn’s voiding trial too early and made me cry. I haven’t cried because a doc yelled at me in ... over a decade? He refused to discharge her, ordered her foley replaced, and said repeat the voiding trial in two hours. She failed that time, too.)
Wednesday: Mr. I Don’t Want a Catheter for My Five-Hour Surgery’s first words upon waking from anesthesia? “I have to pee.” Scanned for 1007 within 10 minutes of PACU arrival, I&O’d for 1100.
Later on Wednesday: Young, healthy, DOC (read: freakishly strong) patient arrives in PACU accompanied by a corrections officer and an apologetic CRNA. Pt has received an enormous dose of ketamine and is batshit crazy experiencing emergence delirium. He’s verbally and physically aggressive, despite arriving restrained at wrist and ankle, which he protests vociferously and loudly with abundant use of both profanity and vulgarity. After 40 of Precedex and 2 of Ativan, 50 of fentanyl finally does the trick. Roughly forty-five minutes after his arrival, three nurses remain at his bedside to do everything necessary in as short a time as possible before he wakes up and starts swinging again. Dude wakes up less aggressive but still belligerent and irritable. I have the “here’s a urinal, it’s okay to pee--no, you’re not getting out of bed, you just had surgery” conversation every 90 seconds for the second time in six hours.
Thursday: CRNA and anesthesiologist (very bad sign) wheel my last patient around the corner and the CRNA’s first words are “we’re concerned about her breathing.” I take one look at the patient and know she’s approaching respiratory failure. MD says he wants a CXR. I open my mouth to ask about an ABG (I know her CO2 is high, it’s obvious she’s not blowing it off) but am distracted by the CRNA starting report, which gets worse the longer she talks. Patient is responsive, oriented, but lethargic and c/o 10/10 pain. Anesthesia asks if it’s ok to give pain meds. Having been burned before, I look up from my assessment and warily ask, “how much Dilaudid?” She hems and haws a bit, worrying out loud about giving narcs with her breathing, until I offer, “we usually give .2, but if you want to give .4, that’s okay.” She does. Pt seems to tolerate it ok, but just does not look good. She’s clearly struggling to breathe. I ask if the CRNA wants an ABG. “Yes!” I’m reaching to call the MD when she asks if I want her to order it. My yes is just as immediate, so off I go to hunt for an ABG syringe. But the ones with needles have mysteriously disappeared since I fetched them for Tuesday’s T-piece patient, so I call CCU and ask them to tube a couple over. (They send me six.)
I’m monitoring heart rate, breathing, blood pressure, oxygen status, respiratory effort, and mental status nearly constantly, drawing labs, doing wound checks and neurovascular assessments, giving IVF and non-narcotic pain meds, trying to get at least something charted, working around x-ray and keeping my patient informed and calm when my coworker passes me the charge phone.
Lab has just tried to call critical results to the teenage volunteer in the waiting room: pH 7.18 and pCO2 78.1. This patient just bought herself an ICU bed. I notify the anesthesiologist, he asks for BiPAP, I tell him to call respiratory, we page the hospitalist for admit and postop orders. I recognize the RT who arrives and chat pleasantly with her as we work on separate tasks for the same patient. Pt continues to c/o pain from her brand-new hip replacement; I’m discussing non-narcotic interventions with the MD and trying to explain to her that it’s more important to keep her safe than it is to keep her comfortable. Things settle enough for me to bring family back, ortho comes out with their last patient, and I snag the resident to chat about NSAIDs. Anesthesia repeats the ABG and I’m just starting to think about calling report when I look up and realize--it’s shift change. This patient is mine for at least another 33 minutes.
tldr; A series of crises forced me to prioritize patient care over playing cards ... or eating, or drinking, or urinating, or even charting.
This is my reward for finishing my second fanfic novel, In Love and War. It almost did not exist--the reward, I mean (well, the fic too, but that’s another story). Not so much because of the closed Ben & Jerry’s near my home, or the first kiosk that didn’t have my favorite flavor, or the clerk at the second kiosk who decided to take her break when it was my turn to order and left me standing at the register for more than 15 minutes. No, this sweet-cream-and-cookies waffle cone almost didn’t exist because I didn’t think I deserved a reward.
Yes, I finished the novel ... but it took longer than it should have.
Yes, it was complete, and people liked it, but ... I could have done better. There were plot threads left dangling and foreshadowing unresolved.
I started writing in November 2014 and finished April 2018, almost double the 15 months it had taken me for my first novel ... how was that progress worthy of celebration?
I did something I’d never done before in six years of writing and posting fic ... I posted an incomplete multi-chap. And then put it on hiatus three times, one of which was ten months long. Again, what’s good or admirable about that?
This fic dragged on so long, and I was so frustrated and unmotivated, that I’d actually decided to abandon it. I’d been secretly considering the idea for months but was still trying to write without much success. The worst thing about not being able to finish ILW was after taking several “breaks” to work on other projects (some of which hadn’t come to fruition either), I’d made a commitment not to work on anything but Romione until it was finished. This left me doubly blocked, not knowing what to do with ILW and not being able to write anything else either, until one day last winter I decided to give up. I would accept defeat and move on to other projects for which I had ideas and enthusiasm.
So in the end, the simple fact that I finished was its own accomplishment. It was hard, both in the writing and mentally/emotionally. I did not want to finish it; I did not care if it was ever finished. The ending gave me no pride or excitement or sense of accomplishment; nothing but a huge sense of relief, like when you walk out of the final of a difficult class with an impossible professor that none of your friends were in and you know you never have to open that book, walk in that lecture hall, listen to that prof, or see any of those people ever again. It is over, and you are through, and you’ve just dropped 50 pounds in the time it takes to answer 100 multiple-choice questions.
Anyway, after debating for about two months, I decided that sticking it out was at least worth a $7 ice cream cone.
Perfectionism is insidious. It will eat your soul and destroy your peace. It is just one of the many faces of anxiety.
Celebrate the victories, my friends--even the imperfect ones.
tldr: Good fit of a single mask is more important than double masking, but if you have one mask with a good fit, wearing a second mask of a different material is helpful.
“Thank you for your service” is all we have ... but never enough.
I don’t want to say a lot about this because I hope to write more about it later, but I took care of a man today who is active military. Anesthesia does funny things to the brain, and I’ve yet to meet a vet who didn’t have at least a little disorientation waking up from surgery.
This soldier was full-on flashback. I did what I could, repeating he was safe, he was home, he was stateside, but he obviously was back in a war zone, reliving an injury and hospital experience in Baghdad. That’s where he told me he was, once he woke up enough to identify himself (by rank and full name): Baghdad.
He cried. He sobbed. He asked about his buddies, demanding to know if they “made it.” And the whole time I stood beside him and held his hand, repeating again and again he was safe, he was home, he was stateside--if he’d just open his eyes, he’d see he wasn’t in a field hospital, he’d see a bunch of civilian nurses in state university colors, not Army green camo, he’d see he was home. Finally, after the longest 15 minutes of my life, that word caught his attention and he turned and looked at me.
“I’m home?”
I smiled big so it would show beyond my mask. “Yeah, [name], you’re home. You’re stateside.”
Then he did something that made me cry. He took a deep breath, said, “I’m home” with the same sense of wonder a child displays on Christmas, and his entire body relaxed. Like cutting the strings of a puppet, this fighter became limp and trusting as a puppy. He still didn’t know where he was, who I was, or what was going on (in fact, he didn’t recognize his wife of 11 years when she showed up minutes later, although he did instantly declare her gorgeous), but none of that mattered. He was on American soil, and he was safe.
He was home.
I don’t care about your politics, or your stance on the American military or what wars we should or shouldn’t be in. I’m not talking about recent domestic events or past war crimes. I’m talking about individual service members, men and women who have sacrificed and suffered in ways we can never know or understand. Thank them for their service. You don’t have to say anything else; you don’t have to qualify it or give a speech or explain who you’ve voting for and why. It doesn’t mean you wholeheartedly agree with every military effort the US (or that particular service member) was involved in. It means you acknowledge the sacrifices of a human being in front of you. It means you are part of home.
