Indigo Girl

Mosaic Used To Be Such a Pretty Word

I took C to the doctor yesterday to have her plantar warts frozen off. She has four of them on her big toe. Our pediatrician looked at them and said, "Oh, we call this a mosaic wart cluster." BARF. I hate dermatology stuff. He's an adorable chemistry nerd, though, and we learned a ton about liquid nitrogen. E and L were with me (they are all off from school this week - fall break) and were fascinated. It hurt C, but I had two suckers with me and she held still and chomped diligently through the procedure. He said he'd never seen a child as brave as she was. She beamed with pride. Aw. We'll wait a few weeks, but she might need to go back. Plantar warts are stubborn.

We went to a Halloween party on Saturday with games, popcorn, donuts, a maze, and inflatables (costume picture here), but I managed to bribe the girls into avoiding actual trick-or-treating tonight. (C didn't care at all and E gave in as soon as the idea of discomfort was introduced. L was the lone hold-out.) I let them choose whatever candy they wanted to fill their buckets in return for not making us venture out into the cold, wind, and rain. I threw in a movie and cauldron punch, too. (Cauldron punch came with L's cauldron for her costume and tasted like sugared sugar water). It took a little doing, but L was convinced when we were heading to C's doctor appointment. She was complaining about the cold, wind, and rain and I said, "You know this is the weather predicted for Halloween, right?" She and E were quite pleased to dress up, eat all the candy they wanted, and hand out candy to the little kids.  

A ran in our neighborhood Halloween 5K on Saturday and rocked a time of 24:41! That's about three minutes off his time from last year! He has worked really hard and is psyched to start running longer distances. The girls and I volunteered for packet hand-out duty on Friday night and held arrow signs again on Saturday morning. It's so much fun to watch the costumed runners run by.

At the race, I was talking to my Swedish friend's four-year-old and she mentioned that her name day was coming up. My MIL said, "Oh yeah, that's a Swedish tradition but I don't know much about it." Turns out that each day has a name or two in the Swedish calendar and you celebrate on the day of your name (or a name close to yours). You can even have TWO name days and celebrate your middle name, too. My name and E's were on there and there were similar names for the rest of our family. My friend says they do something smaller than a birthday - a little celebration and gift. I think this is a HUGE Swedish family fail for A's family. What an awesome tradition! We are incorporating it IMMEDIATELY.

Last week I woke up in the middle of the night and worried for over an hour about my new job and what we're going to do if a kid gets sick and what we're going to do for Thanksgiving/Christmas vacation and what we're going to do when my in-laws are gone for spring break and I still have to work three days. Obviously, middle-of-the-night fretting did not solve anything (DAMMIT), but when I told A, he had a lightbulb moment. He checked to see how much vacation/sick time he has for the rest of the year and guess what? It's a couple of WEEKS worth. Suddenly, my stress is WAY less. I have vacation time, too, but I would like to establish a reputation as a hard worker before I start taking vacations, you know? It's hard to lose a reputation as a slacker.

L wants to learn to type fast. The Mavis Beacon for Kids gets really bad reviews. Any other home typing program suggestions?

This prison lingo list makes me wish I had read it years ago. I would have memorized it and made it the only slang we ever used around our kids. As it is, A and I are saying things to each other like, "She's on the bumper. Don't let her in the car" and "Don't sell me wolf tickets" and "I got jigs" and "Oh, she had such monkey mouth." I want to print this out and carry it around with me so I can work these phrases into my conversations as often as possible.

Thursday

I made this pork the other night and it was fantastic. Any recipe that has me squeezing entire cloves of roasted garlic into a sauce is on the up-and-up. I was apprehensive about roasting pork in my oven - I rarely get a tender result. We are usually using steak knives to cut it and chewing it a million times. This was perfect, though, and everyone loved it, even C who is an infrequent meat eater. The leftovers were gone by lunch the next day. This is not helpful when it comes to my Leftovers for Friday Dinner plan, but it IS gratifying.

I didn't write a Five-Year-Old summary for C and I probably won't get to it (poor third child!) but this conversation happened last night and it is such an accurate snapshot of who she is that it probably covers a longer blog entry.

We read Alexander and the Terrible, Horrible, No Good, Very Bad Day before bed. (A worked late, so no Harry Potter and the Order of the Phoenix - I cannot do voices.)

E: "Wow. He had a bad day."

Me: "Yeah. I've had days like that. Have you?"

E and L, knowingly: "Oh yeah."

C, brightly and cheerfully: "No!"

I'm going to a bar tonight to watch baseball. I don't usually do either of those two things, so to do them together is odd. It's a coworker organized event and there will be half-off martinis and I'm excited to order mozzarella sticks. I only mildly care about professional sports. I am much more interested in chatting with people and shoveling mozzarella sticks in my mouth.

Lastly, Twitter directed me to this post about altruism and I want to read it over and over and then make YOU read it over and over and then we can pass it on to the world and we can all live like this. 

(More) Proof That I Am Impossible To Please

Evidence The First

E read a book at school called Hatchet. We had a conversation about it. It went like this:

Her: "I read a really good book at school! It was called Hatchet."

Me: "Oh? What was it about?"

Her: [TALKS FOR HOURS AND INCLUDES EVERY PLOT DETAIL EVER OMG]

Me, interrupting: "Sounds great! We have to get going now. Can you sum up the rest?"

Her: [TALKS FOREVER AND NOW I'M DEAD OF OLD AGE]

I didn't realize that the ability to sum up an idea or story is a learned behavior. I am a conundrum - I love details, but I want those details to be given quickly and comprehensively because I'm impatient. In critical care, I take care of one or two patients and my report to the next nurse can take over thirty minutes. We give a lot of detail, but sometimes have to sum up weeks of complicated events.

I am glad for her attention to detail and reading comprehension, but I do not want to listen to hours (okay, ten minutes WHATEVER) of Hatchet summary.

Evidence the Second

At our neighborhood grocery store, the main baggers are awful. They are incredibly slow older ladies and instead of putting things directly into my bags, they place them back onto the counter. I take this to mean that I should start bagging my own groceries because otherwise they will scan the entire contents of my cart and then start looking around like "Hmmmm . . . was there maybe something else I should do?" 

I don't mind bagging my groceries. I have fully functional opposable thumbs.  I can arrange things to my liking. At the same time, I think: would it be that hard to put my items directly into a bag after entering the price? I know not everyone loves efficiency like I do, but when your job is to move a line of customers along, you should be acquainted with efficiency.

 Then I go to Meijer and the cashier DOES bag my groceries for me, but she does a such a crappy job that I'm still not happy. My bags can handle a lot of weight and I tell them that. (Nicely.) I am also not an older lady with atrophied muscles. I can lift grocery bags that are packed with groceries. Do not put one or two things in the bags so that you run through my TEN BAGS and end up having to use the plastic bags and then put one or two things in EACH PLASTIC BAG so that my head explodes right in your line. Today she put a single four pound bag of brown sugar in a bag all by itself. Then she put two half gallons of milk in a bag together. This was all because she had done such a crappy haphazard packing job of my reusable bags.

Okay! I feel better.

(Non) Exciting Things

For the last few weeks, Twitter has been all abuzz re: BB cream. I caved and bought some yesterday, expecting to be stunningly beautiful in short order. It was a little heavy compared to what I'm used to (a little concealer and powder), but I liked it. Full disclosure: I did not receive ANY marriage proposals or modeling contract offers. My understanding is that my skin will become MORE stunning the more I wear the cream. Scam? We shall see.

A took the girls to baton lessons and while he was waiting for C in the bathroom, he captured proof of a child named Obvious. Poor kid. The jokes WE made are probably just the beginning.

I had my exit interview this week. I joked on Twitter that I put on my Honest But Tactful pants. Unfortunately, the tactful part fell off and I was left only wearing Honest Pants. I stuck to experiences that I personally had - no rumors/gossip - so I think it went well, but I was brutally honest. The HR lady filled many sheets of paper taking notes. (It was very odd to have someone taking notes on what I was saying. I've never had that experience before.) Near the end, I told her that it was hard to say all these negative things about a unit that I've loved so much and she asked me what was going well, so I was able to end with the positive. That made me feel a lot better.

 I have also done some very exciting things like clean out my closet, sort through all the kids' clothes, make caramel apples with L, put flannel sheets on the beds, volunteer at school, make Pad Thai with A's cousin, organize the hair accessory drawer, get my teeth cleaned, find E some jeans, and finish all our Halloween costumes (Hermione, life guard, Snow White). 

E got new glasses (purple this time!) and every time she does, I'm thankful to Swistle for mentioning Zenni Optical. I used to pay close to $300 for E's glasses from our pediatric opthomologist and when she was an infant/toddler, I probably needed to get them there. Now that her prescription is slowly improving (she used to be +6.5 in both eyes, now she's +3!), I can get two pairs of glasses online for less than $100. Plus I get the no scratch coating, clip on sunglasses, and anti-glare. The downside is not getting to try the glasses on, but she has quite the round face, so angular frames are in her best interest. The sizes are posted clearly, so I look for ones that are slightly larger than her current glasses. I usually comb through all the glasses and choose the ones I think will work. Then she picks from those. 

Things Worse Than Death

I need to write about why I am leaving my current job in cardiothoracic critical care. I realized this when I said to A, "Oh, there are things worse than death. [pause] Hey, that's what my job has taught me!" I mean, honestly, I can't gloss over that. 

For those of you who have read for a long time, you know I've loved working in critical care. It's hard and physically/emotionally draining, but I have gotten such a sense of peace and satisfaction from helping people in the middle of a health crisis. I've written about it here and here and here and here.

There are some logistical reasons that I'm leaving - the main one is that it seems silly to be at home during the week when the kids are at school and A is at work and then go to work on the weekends when everyone is home. I'm also ready to have holidays off and work during the daytime hours. I could easily meet most of those requirements by working day shift on my unit, though, and I choose not to.

Another somewhat superficial reason I'm leaving is the management. I know, everyone always complains about the management. The thing is, I've been there for over eleven years and through at least four managers I remember and I've never really noticed management before, so I assume they were at least competent. Currently, the search is on for a new manager and a set of supervisors are in charge. None of them have a lot of training or experience in management and the result has been a lot of negative feedback to staff, nit-picking and micromanaging, and lack of support when our census and acuity are high. They also choose the most ridiculous hills to die on and therefore alienate staff. The morale on our unit is low. A lot of us are angry and frustrated - it feels like we are being given more and more unimportant tasks that take us away from actually caring for our patients. No, I don't have time to talk to my patient's family - I have these twelve extra things to chart on first. Unfortunately, one of these supervisors is a finalist for the manager position.

There is very little communication between our supervisors and our medical director. She didn't know how high our nursing turnover has been and how short-staffed we've been. She was shocked. It's like little kids trying to cover up their mistakes and not thinking things through. To teach us a lesson, they gave everyone on the unit a poor mark in the Patient Satisfaction section of our last evaluation and when someone asked, "Will this affect my tuition reimbursement?" she was told, "Oh. We don't know. We didn't think of that." (The answer was yes, by the way.)

These are minor quibbles when compared to the moral and ethical dilemmas causing most of my struggles. Let me preface them by saying that we do some amazing things in cardiothoracic care. We do save lives. We can put in a sort of artificial heart in order to keep someone alive and active for a few more years or until s/he gets a heart transplant. We do heart transplants and will soon be doing lung transplants. We have almost a dozen cardiothoractic surgeons who are involved in different studies and providing excellent surgical services to people who otherwise would need to travel hours for their care. We have a group of heart failure physicians who I would follow to the ends of the earth because they are everything physicians should be. I've learned so much in the last eighteen months since this unit was created.

I'm going to talk about ethics now and I want to make it clear that I know these are ethical and moral dilemmas for a reason and some of you out there will have different beliefs than I do. I give excellent care to all my patients. We do not have to agree or get along or even like each other for me to care for you to the best of my ability. I will advocate for you and push for the best care for you, the care that you want.

On the medical critical care unit, the care is directed by a pulmonologist/intensivist. S/he is a lung doctor trained in critical care. When I worked there, I felt like we worked as a team with the patient and families. We tried to ascertain the patient's wishes, either by a living will or other legal document, or by what the family said s/he would want. It wasn't a perfect system, of course, but we tried. We would do everything we could to save someone and a lot of times we would, but sometimes there would come a point where the intensivist would sit down with the family and say, "We've done everything we can do." Our care would shift to keeping the patient comfortable and helping the family begin the grieving process.

We do not do that anymore, not in cardiothoracic care. It doesn't matter what you wanted before - now you've had surgery and you signed up for these potential complications. You'll have to see them through. No one is allowed to die and certainly not in a peaceful way. Any death is traumatic and contains chest compressions, trips back and forth to the OR for more surgical interventions, more tubes, more machines. When they talk about rising healthcare costs, especially in the last few days or weeks of life? Yeah, that's us.

I don't want to disparage the choices that people make. If a patient tells us, "I want to fight until the end," we do. I am behind that 100%. But when they tell us that they're done fighting, when families tell us "S/he wouldn't want this," when we still press on in the case of futility . . . I can't do it anymore. I can't see their wishes brushed aside so easily. I was trained to advocate for my patients. In critical care, I am their voice. I move between the different physician specialities, translating medical jargon for the families if necessary, ensuring that their questions are answered adequately, reminding us all that at the heart of all this technology, there is a person with intrinsic worth and values and we need to honor them. For the last few years, I've felt like my voice - the patient's voice - is no longer being heard.

I am thinking of the ninety-year-old previously independent man who had heart surgery and ended up permanently on the ventilator and with renal failure. His skin blistered all over, he was in excruciating pain no matter what we did, he didn't want any care, he kept mouthing, "Please let me die" to us. 

I am thinking of a man in his sixties who explicitily told his family that he didn't want certain invasive interventions like to be on a ventilator. When he was unconscious and unable to speak for himself, they told the doctors, "He would want this. Do everything." This took him on a journey of every single cardiac intervention we have. He was in our ICU for over two months and when he could speak again, the first thing he said to his wife was, "How could you do this to me? I would never let you be in so much pain." 

Every time I took care of patients like this, I felt like I was torturing them. I felt like I was disrespectful of their humanity.

This past weekend, I got pulled aside before I took my assignment. The day shift charge nurse said she'd put me in there for a reason: she needed someone competent, compassionate, AND able to explain things to the family. I get that regularly. A few months ago, the PA assigned to my patient told me that she'd asked specifically for me. These are great ego boosts and I'm not going to turn them down, but it adds to my guilt in leaving. I'm good at what I do. I make a difference in the lives of my patients and families. If I have a strength, I believe I should be using it. Am I giving up? Should I fight harder to change the morale and environment on my unit?

I think this is an eternal struggle with caregivers. There comes a point when we need to be selfish and put ourselves first, but it feels foreign and wrong. I'm going to have less patient interaction in my new job and that thought makes me feel like I'm about to take a strong, cleansing breath. I can still provide a positive experience to the patients I see, but I'm ready to take a step back. I'm burned out - a phrase I never thought I'd say about myself - and if I stay where I am, I'm afraid I'll do more damage than good. 

Height Avoidance Confirmed

We went to a big amusement park this past Saturday and had a blast. We are almost at a perfect spot, age-wise, with the girls and rides. (Perfect, to me, is when everyone can ride everything and we can ride big rides as a family. I think there is a narrow window for that spot and then we'll quickly move into "We want to go off alone without parents!") We spent twelve solid hours at the park (9:30-9:30) and everyone was cheerful and thankful and non-whiny. Most importantly: everyone was willing to try ONE new ride that was slightly out of their comfort zone AND everyone LOVED that new ride!

One of the first rides that E and I rode was The Raptor. She was nervous because it went upside down and her experience on The Corkscrew had been bad. (She had hurt her back, the old lady.) Well, she loved it, got a hilarious adrenaline high that made me snicker at her talkativeness, and we stood in line again to ride it at night. 

Post ride pride.

C rode The Scrambler . . . oh, I don't know . .  . a million times? I think every picture I have of A is on The Scrambler with C. She also nervously rode her first ever roller coaster and screamed happily, hands in the air, the entire time. It goes six miles per hour, folks. 

L had tried a roller coaster when we came in July and it had left her literally trembling with fear. Poor kid. I convinced her to ride the lamest one - The Mine Ride - and she loved it. We had to immediately get back into line and ride again. 

She is GIDDY because she has CHEATED DEATH.

 Everyone had ridden everything they wanted to ride by 5 pm, so the rest of the day was gravy. We re-rode favorites, ate cotton candy, and explored a few of the Halloween activities. L spent most of the day like this:

I knew she would, so I made sure to get two maps when we entered the park. I need my map, too.

At the end of the night, I rode the ferris wheel with E. She had been talking about how great it would be to ride the ferris wheel in the dark and even though I don't care for heights, I agreed. I had just come off three spins down the Skyline, so I think I was extra sensitive to being freakishly high in an open ride. I can't remember ever riding a ferris wheel before and now I know why: the ferris wheel SUCKS. We were fine at first, but then we both got scared when it went high. It wasn't so bad when it was going around and around, but they can only load/unload six cars at a time, so you spend AGONIZING MINUTES multiple stories up in the air, staring at the floor of the car and trying to breathe as shallowly as possible.

I could see how terrified E was and, you guys, I would do anything for my kid, but I was paralyzed with fear. I was sure that if ANYONE MOVED, we would careen out the window to our deaths. So I started chatting about her Halloween costume and stuff we had done that day . . . anything that came to mind. When we were finally (FINALLY) safe on solid ground, we agreed that the whole experience was horrible and we'd never go on a ferris wheel again. Then she looked up at me and said, "Thanks for helping me." It was a really proud mom moment for me and I was proud of her for being so brave and calm in the face of her fear. 

We spent the night in a crappy motel with a surprisingly good free breakfast and came home Sunday. 

Today was baton lessons again. I made sure to bring my camera and when I said, "Okay! I want to get a picture of you guys with your batons!" they immediately began sword fighting.

Remember how we kept the biggest baby snail for ourselves and named him Hagrid? I was watching him yesterday and he is astoundingly huge. For comparison, I pulled a large snail out of the snail-only tank and placed it beside Hagrid and a penny for scale.

I hope that he doesn't grow like the goldfish in A Fish Out of Water.

Here's mother and son (or daughter, L pointed out):