The saying is that nice guys finish last. That saying has been around forever. But, do they really? Or does it seem so just because the “nice guys” quietly win, and don’t draw attention to themselves while doing it?

I had two really nice patients the other night. And then two really nice patients the next night. These are people who are in the midst of health crises, and still adhere to being polite and pleasant. This is not always the case, and I don’t blame anyone for being bitchy when they’re sick or injured. I get it, trust me. But these sets of patients were each kind, patient, understanding and appreciative of their care and the education given to them. At the end of my day, I invariably tell my patients that it has been a privilege taking care of them, because that’s true. One of these patients took my hand and said “well, it’s been a privilege being taken care of by you”. One of the nicest things said to me in recent times, from a sick and hopefully healing person.

I have someone I barely know through the beauty of social media, who read my last blog post “Refreshments and Narcotics”. And took it upon himself to send me a video message thanking me for being a nurse, saying “wow, it sounds like sometimes you could use someone in your corner, so let me be that person today who thanks you for what you do” and even gave me a book suggestion to help deal with stress (amazingly, to a book I already own, thanks to a doc friend also suggesting it to me some time ago). This is someone who is busy with his own life and things going on taking a few extra minutes to just give a relative stranger a pep talk.

So, do nice guys finish last? Or are nice guys quietly out there making the world a better place for everyone in it? Out of this wonderful group of people I’ve recently dealt with, I don’t think any of them are finishing last. And I’m appreciative for what each of them has brought to my life. Because I don’t want to live in a world without those nice guys in it.

I’m not a writer, I blog mostly for myself, so no editorializing here please.

Don’t call me a hero. I’m not one. Heroes are those crazy folks who rush into burning buildings, not concerned for their own safety. Trust me, I’m concerned. I’m SCARED for my safety. I’m not a hero. I’m just a nurse.

So now we are over 44,000 Covid-19 deaths in the U.S., even as some states are considering loosening up restrictions. And I understand how frustrating and boring it is to be staying at home all day, every day, and how shitty our economy is right now. But, I doubt that a bunch more dead folks will help the economy.

For those who still say that C19 is no worse than the flu, go for it, keep your delusions. True, the CDC numbers on the flu this year are undetermined, but that somewhere between 29,000-59,000 will have died from the annual flu. That’s a big range. That’s also over a 6 month period. We have 44,000 dead from Covid in less than 2 months. And some of those flu deaths could have been prevented, because we have you know, a VACCINE for that virus. Nothing for this one. Nothing on the horizon either, since the CDC themselves say an optimistic estimate of about 2 years for an effective vaccine.

So what happens to a Covid-19 patient? So glad you asked. First of all, I go into the room wearing a gown, double-gloves, and this crappy, loud-ass thing called a PAPR (pressurized air purification respirator). I look ridiculous, like some extra out of Star Wars, and I can’t hear you and you can’t hear me over the sounds of the PAPR. The doc may ask me how the patient’s lung sounds are, and I say “I’ll be damned if I know”; when said doc shrugs and says “fair enough”, you know that this thing is loud. So here I come into your room looking like this:

Yeah, seriously, the PAPR is not a good look for anyone.

Covid-19 causes shortness of breath and severe hypoxia. Trust me, we’ll try to oxygenate you, using all of our abilities, and try NOT to intubate you. Because the odds are if you are intubated, you’ll die. Somewhere around 70% of folks who get onto a ventilator will not get off of it alive with this virus. It goes against the grain of the pulmonary doctors, to watch a patient struggle for breath and to try to NOT intubate them. But there you go, this thing is a vicious piece of shit.

You fail. No, not you personally, but you go into respiratory failure, and we end up intubating you. Then what? Well, imagine breathing through a straw; and imagine another loud machine forcing you to take a breath when you aren’t ready for it. Imagine the discomfort of struggling to breathe even though you are on life support. A lot of these intubated Covid-19 patients will struggle against the ventilator, overbreathing the machine or ineffectively breathing against the machine. There are times when the sedation we put you on to help you tolerate the ventilator is not enough. There are times when we have to actually chemically paralyze you to help your body work with the ventilator. So imagine you are not able to move or even blink, but may still be awake enough to be aware of this. To make sure we are sedating you appropriately to not be just freaking torturing you, we add another piece of equipment to the mix, a sedation monitor. That gives us a constant reading of your brain activity, to tell us if you are adequately sedated to be on the paralytic.

Keep in mind, we’ve also put a catheter into your bladder at this point, because Covid-19 will also cause your kidneys to shut down, and we need to be able to monitor your renal function and urinary output. So that is another tube shoved into you in an unpleasant area. It is not uncommon for people to end up needing at least temporary dialysis while being treated for Covid-19; add another tube, a dialysis catheter, usually a neck or chest vein. Additionally, at this point you have multiple IV sites, in arms, and possibly neck or chest as well.

Oh wait, I’m not done yet. Do you know what else Covid-19 and its treatment does to you? It gives you the shits. Yep, diarrhea galore. So to protect your skin, since it frequently is continuous poo, we’ll sometimes also put in a rectal tube to keep the poo away from you. How dignified is this sounding at this point?

Your family is frantically calling, multiple family members, multiple times a shift. I can’t remember who I have already talked to, and we try to establish one person to be the family point of contact. But that doesn’t always work. Your family is terrified, crying on the phone, and unable to come in to see you. We try to set up Facetime, so they can at least see you, even though you are not at your best.

Our pulmonary docs are frustrated and at some points near tears with their inability to ventilate you; you get to the point where you can’t be oxygenated, even on the ventilator, even on the highest of ventilatory settings. To quote one of our docs one night “I can’t even oxygenate someone on a ventilator, what the hell did I go to school for?”

You’re dying. Sorry to say this, but it’s true. There is only SO much that we can do, and only SO much that our treatments can do for you at this point. If you are over 50 (although we’ve lost patients in their 30s and 40s). If you have an underlying medical condition. If you are male (it seems more disproportionately that the men are dying). If you have darker skin, either Hispanic or African-American. You are more likely to die.

Your family cannot be with you as you are dying. We desperately contact your family with your condition, attempting to get the “DNR” or “comfort care” order so that we do not have to pound on your chest, fill you with chemicals and shock you repeatedly to try to get you back as you drift away. But even if we get those orders and are able to let you quietly go, there is drama. Because you are ALONE. No family can be in with you. Yes, I as your nurse will try to be in your room with a phone, letting your wife and children tell you goodbye. I believe that no one should die alone, and I try to stay with you. I even hold your hand. And you can’t even feel it, you have no physical human connection as you are dying, because I am in there wearing a PAPR, and two pairs of gloves.

Even as you are dead, even as we treat your body with respect as we clean you and remove the tubes and lines, we are gowned, and gloved, and PAPR-ed. You don’t even get that little human connection as we are preparing your body, putting you in a double body bag, and taking you down to the morgue.

Covid-19 takes lives. It takes away humanity and human connection. It takes away individuality. It leaves pain, heartbreak, frustration, loneliness. It is powerful, and it is brutal.

We have no vaccine for this virus yet. We have limited treatments that “seem” to work on some or even most people. We don’t even have sufficient testing yet, for the virus or antibodies (yes, some areas have more test kits than others, but we are still not testing frontliners at this point). This is an invisible opponent that we as nurses (and other front-liners and first responders) are desperately trying to fight. Because our job is to save you, and it is SO FUCKING MISERABLE when we can’t. And when we can’t for young people, and multitudes of those people. We have lost some of our own front-line staff. Our front-line staff has lost some of their own family.

But tell me again how inconvenient it is for you to not be able to get your hair done, or to not have your children in school, or to not be able to go out to dinner?

Yes, I get that the economy is in the shitter right now. I repeat, a bunch more dead people are not going to change that situation.

Don’t call me a hero.

So, I was in Los Angeles for a few days for a nursing conference (FABULOUS event, BTW). L.A. is a LOT bigger than my city size of choice, that’s for sure. But, I went forth with trepidation.

Day one, I had gotten there after an hour flight; sleeping sitting upright because I had worked the night before. Get to LAX, try to meet my Uber driver…huh, well, so I’m like two floors below where Uber drivers pick up. Funny, because there is road here, and cars and taxis here. Just a little input for LAX….SIGNS are a very civilized way of telling me “hey dumbass, Uber is upstairs!” Anyway…..

Get to my hotel, which lets me check in slightly early, because they have a “petite room” clean and ready. OK, so this petite room….it was fine for me and my dimensions that I’m used to, but there is no way that 2 people are going to be ok in this room together! But it’s nice enough, and has a Keurig in it, which is a huge step up from regular in-room coffee makers that I’m used to.

Get an Uber again to the beach, and walk around a bit, get toes in sand and toes in COLD Pacific ocean water. Amazing how 60 degrees feels warm in Reno, where we are limping into spring, but feels cold in L.A., which I was expecting to be 80! Also got a look at Tom Hanks’ star on the walk of fame, so yep, I’m good for the day.

Get to view the Hollywood sign up close and personal and get a quick beach trip the next day after the conference ends in the afternoon. And had some awesome Italian food for dinner with a friend who lives in the area.

The final day, leaving after the conference….Yeah, not a great plan, having to get to the airport (or anywhere) at 5pm. Good thing I gave myself 4 hours before my flight was due to take off! My Uber driver opted to get to the airport via back roads and no use of the freeway….hmmm, bold move dude, and maybe the best. I don’t know, actually; I think that both ways would be fraught with paralyzed traffic. Meanwhile, we go through like 12 different cities on his interesting trip to the airport. I used to think that California town size was based on how many Denny’s it has; now it’s based on Trader Joe’s and Ralph’s markets. I swear we passed by 20 of each.

Oh, the joys of the security check. There is something inherently gross and demeaning about having to march up to a uniformed person with bare feet. And I still protest that the body scan with the arms up position doesn’t count for my annual mammogram.

Why is it that the gate my plan will (eventually) be taking off from is the only one up in a blank, boring corner, with no shops, no food, no bathrooms, etc? Oh yeah, because it’s me!

Getting onto my flight about a half hour later than I was supposed to, I was watching the flight attendants’ half-hearted presentation of the safety precautions, thinking to myself; someday, I just want to see one of these folks say “look you idiots, if you can’t work an effing seat belt, you really shouldn’t be wandering around alone”. What a PITA that presentation must be…over, and over, and OVER………

Home at last, reunited with my furbuddies, and happy to not live in a city with a 5 hour rush-hour traffic window!

So, do you make new year’s resolutions? Those fleeting thoughts of “I should…..” that go the way of the dodo bird within a few weeks? Yeah, I’m in that boat. “Be nicer”. “Curse less” (hahahahaha, that one always makes me chuckle!) Lose weight. Read more books. Journal. Evolve as a human being. Etc. And with the exception of the last one (let’s face it, we’re always evolving), I don’t succeed.

There are two I have managed to succeed with in the past few years. One is a social media initiative, in which for every person on my Facebook friends list, I at least once during the year send them a special note thanking them for who they are to me, and telling them what I like and appreciate most about them. This is now going into year 3 of doing this, and it’s one that I have seen through the entire year.

The other is to publicly repeat the “100 days of happiness” challenge, by stating (and usually posting a photo of) something each day that makes me happy, or smile, or just improves my mental status somewhat. While I’ve done a full year of “happy days” before, I now stick to completing the 100 days each year. Let’s face it, if we lower our expectations, we have a much better chance of success! 😉

This past year (or a bit more, actually), I have been struggling a bit with the depression and anxiety that have been a part of my life for as far back as I can remember. There have been ups and downs, but I have yet to get it fully under control. And so, this is the year of control!

Yes, the year of again journaling! (although by not telling myself that I will do it daily helps me to succeed; lower expectations!) A year of getting outside more with my little furry, four-legged buddy. A year of being around family more. A year of further challenging my abilities to improve at work, and to elevate myself as best possible. To exercise more (maybe lose weight, maybe not, but release endorphins!) Read more (thank you, Pop Sugar challenge!) To meditate more and spend more time in quiet, calm things, rather than mindless television on for background noise. On to moving forward into more of the life I am capable of.

Move aside, here is MY fight song! (Thanks Deva!!!)

Here’s a few things I’m realizing that I’ve learned, either over time or recently, through nursing:

1. How incredibly nice a person is will be directly proportional with how terminal their illness is. Yep, sad to say, some of the very nicest people you will ever meet are on the oncology floor….for the final time. I have nursing students in clinical right now on oncology and neurosurgery; it is an incredibly depressing clinical rotation for all.
2. The more entitled patients are going to be the younger generation. Yep, 90% of the time the patient you flat out CAN’T please will be in their 40s. Or 30s. Or 20s. Or a retired nurse! 😉
3. We have taught our younger generation to not be able to tolerate pain. At all. Yep, the 90 year old lady with rotator cuff surgery can last 12 hours off of 2 Tylenol. The 38 year old with a minimally invasive procedure needs Dilaudid every 3 hours and complains that it is not enough. People kind of need to realize that SOME pain is inevitable; but the expectation today is NO pain.
4. You are always a psych nurse. It’s funny, when I left full-time psych nursing nearly 20 years ago, I thought that I’d “left” psych nursing. But no, you never leave psych nursing. Because sadly, the number of patients with a concomitant mental illness has exponentially increased. Whether because we are doing a better job of identifying these illnesses, or we’re over-diagnosing them, I can’t say.
5. It’s all about the poop. Or pee. Or other bodily juice or fluid! Seriously, as nurses, we may not LOVE that stuff, but yeah, we want it out of you. In adequate quantities. Hopefully looking the way it’s supposed to. The only thing you can keep in ya is your blood. Please keep that to yourself. Or else my busy shift gets much busier…and quickly.
6. Illness, injury and the stress of hospitalization can either exacerbate a person’s worst tendencies and characteristics….or bring out the greatest strength, patience and kindness imaginable. Both responses to stress need to be recognized, acknowledged, and dealt with in the same kind/respectful manner.
7. I realize the need we as nurses have to distance ourselves from the stress and horror we deal with on a regular basis. I get it. Hell, even I do it from time to time, with my dark and twisted sense of humor. Whether it is the pitch black humor, or the stepping away from the person by calling the patient “room 203” or “the appy down the hall”. But GOD I hate that. That isn’t the “appy down the hall”. That is George, or Mr. Smith. That is your PATIENT, not a room number or diagnosis. While I understand how nurses do that, I freaking hate it. I have my black humor as a survival mechanism; but I won’t dehumanize my patients to desensitize myself to what they are going through. When I catch myself doing that, it’s time to go into office work or something.
8. We, as nurses, are collectors. We are given the gift of collecting moments, and special interactions, that other people will never have the opportunity to have. My life is enriched by every person I share the universe with, whether it is a pleasant interaction or a challenging one. From everyone, I gain and learn; and the moments we gain as nurses working with patients are unlike any other moments we will share with people.
9. Everyone has a story. That patient in that bed, that is NOT who that person is on a regular basis in their life. Find out who that PERSON is, not just who that patient is. And feel honored that you get to be a part of their story, even if it is only a small part.
10. The amount of poo and it’s consistency will be in indirect proportion to the amount of help you have in cleaning it up! (and will be directly proportional with how tired you are and how late in the shift it is; yes, the awesome intense blowouts will often occur after 5:30)

It is challenging, and hard. I get drained and tired at times. But I know, truly, how blessed and lucky I am to be able to be a part of this profession. There is no more rewarding job on the planet than providing care, respect and dignity to those who momentarily have lost their own.

I was talking to the spouse of a patient the other night, learning about their lives together, their marriage, how they’ve raised their children, what brought them to our state, etc. I swear, sometimes I feel like a “Criminal Minds” profiler, with all of the questions I ask patients and family members! But I do think, especially with patients having confusion, knowing something more personal about them can help. It can help with establishing/re-establishing rapport, can calm the patient, and give them something different (and more positive) to focus on. So, yep, I ask away.

Anyway, this lady and I were talking, and she said that they’d raised 6 children together. As we continued to talk, she said that she and her husband had a special way of dealing with their children’s squabbles. The children could yell at each other and (verbally) fight; but they would have to argue using Sesame Street voices. Imagine; fighting with your sibling over the computer as Bert and Ernie. Drawing swords over the last Eggo as Cookie Monster. Bathroom wars as Big Bird and Elmo. I asked her how bad their kids’ fights would get, or how long they would last; she laughed and said not long. Usually, all kids involved would be laughing within minutes.

I think this is brilliant! With all the difficulties and stressors of parenting, these two came up with such a creative and ingenious way to settle fights amongst the kids, and get them to the point where they could actually communicate with each other, and compromise, without anger. I think that this same tactic should be used in the adult world! Imagine debating politics, or arguing over a parking spot, as Kermit the frog and Miss. Piggy!

I am considering doing something similar in my own life. However, since I totally can NOT do any muppet voices, I’ll take it to an adult level, and throw random quotes from “Airplane”, Monty Python, or “Princess Bride” at you. Surely it will get the point across (and don’t call me Shirley). So if I approach you declaring myself to be Inigo Montoya, you know I’m cheesed off at you! Until then, “I fart in your general direction. Your mother was a hamster and your father smelt of elderberries…”

…..But, I don’t understand the need to belittle others in order to feel “big” or “right” or “important” yourself. Really? So, by insulting me and how I think, or look, or act, or dress, or WHATEVER, that makes you a better, brighter and more accomplished person? Wow, it’s such a great road trip, reverting to the age of 10! 😉

I guess, I just don’t understand this massive judgement that so many people have. I mean, it’s human, I have it also. If you are an idiot by choice, by deliberately narrowing your mindset and being unwelcoming to any alternate opinions/facts, then I think you are a waste of the good O2 that I could be sharing. But if I have to set my standard to being “I’m better/smarter than you because….” of what I wear, or the color of my skin, or whether my sexual organs are innies or outies, or who I’m attracted to, exactly how does any of that make me the better person? It’s lunacy in it’s very concept. Perhaps that is how the narrowminded think….but it’s not what I choose to believe is reality.

Today’s climate is sadly less civilized than prior generations. All it politicized, and where there be politics, there be anger, intolerance, and straight up hatred. It seems that we can’t escape it; and since it is inevitable, then it is up to each of us to decide how we are going to behave, and who we are going to be in this society.

I fully admit to being an idealist. I see nothing wrong with that, and if you do, well, I don’t care. I will show you kindness, I will show you patience, I will show you respect, acceptance and tolerance; until you show me your true colors that are the antithesis of these things. And then I will show you the door. Because life is too short, and really, to spend time arguing with these kinds of people is pointless; “never engage an idiot, because they will bring you down to their level and then beat you with experience”.

As Michelle Obama has said “when they go low, we go high”. YES. This is what being an idealist is about. Behaving in the IDEAL way that I would want from others. I can not force others to act this way, and I have no desire to. But I will NOT be pulled down to a level that beneath me. I’ve done that before, and trust me, the air is much cleaner on the high road. While others may talk about how strong, how right, how tolerant and how correct they and their behavior are…..show them the truth by showing them yours.

I am one person. But I can be an example. “Be the change you wish to see in the world”.  In the past 5 years or so, I have changed exponentially for the better. I have fought to become who I am, and to maintain my idealism throughout the process. Like it or not, you’ve got to respect that.

Or there’s the door 😉

So, in the years that I’ve been alive, I’ve learned a few things about myself. I have an ongoing affair with depression. I am thinking that more and more, in this day and age, a lot of folks could say the same. My depression is not the kind that lends itself to emotional lability and dramatics (well, not most of the time!) Mine goes towards the apathetic, low-energy kind.  I tend to isolate, to be lazy about exercise and other self-responsibilities (although the dog must still be walked, of course), and just overall act like a vegetable. Not a horrific existence, but not the one I want or deserve. Once I had gotten onto the path of happiness, it became my spirit journey, and I didn’t/don’t want anything to interrupt it.

I’m reminded of the Native American proverb about two wolves:

An old Cherokee is teaching his grandson about life. “A fight is going on inside me,” he said to the boy.

“It is a terrible fight and it is between two wolves. One is evil – he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.” He continued, “The other is good – he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you – and inside every other person, too.”

The grandson thought about it for a minute and then asked his grandfather, “Which wolf will win?”

The old Cherokee simply replied, “The one you feed.”

I choose to feed happiness. And so looking at things in my life right now, I decided to take an active role in doing just that. There are some responsibilities that I can certain be more proactive with and decrease some stress and anxiety. There are some things I can leave behind that are not being helpful to me right now. There are people who are positive for me to be around, and others, maybe it’s time to mentally let go. In this time when personal responsibility seems to be scattered and fleeting, I’m choosing to feed my happy, and anything that starves is at this point, needs to go.

Find your happy. Feed your happy. How much say do we really have over all of this? As much as we choose to take on. I will….time for dinner.