New Days, New Ways

img_1411A promotion at work started 2017 for me, dropping me into a tidal wave of new learning and stretch assignments that I continue to float within now.

Evenso, I was lucky enough to sneak up to Boston last week and complete my second residency week of the certificate program at the Center for Narrative Practice, which I have studied in since August. The faculty, largely led by Columbia University’s Narrative Medicine folks, led us through a hands-on curriculum, designed to equip us with the practical tools required to lead narrative exercises in our unique clinical settings.

I’ve been thinking about the class since returning to my new job this week, itching to test out my new learnings. With my title comes some freedom to fashion the meetings that I’m responsible for, and a group of bedside nurses selected to drive quality improvement across my organization seemed the perfect group.

Today’s meeting was our first together, and after some expected technical difficulties and “Why are we here?” questions, I posed the choice: Should we proceed with didactic training via a colorful powerpoint I have prepared, or take a more creative route to understanding quality by…reading a poem?

To my surprise, the group wholeheartedly embraced the literary choice, and together, we read, discussed and wrote reflections on George Ella Lyon’s poem, Where I’m From.

Our rich discussion, which ranged from literary analysis to family history, ended with one nurse’s summary: by witnessing each other’s stories and recognizing our own, we see and remember that each of our patients comes from somewhere, too, and that asking them the simple question – “Where are you from?” – might lead to beautiful, unexpected findings.

It goes without saying, but I’ll say it anyway – I couldn’t have dreamed for a better, more engaged synopsis and group response, and I am excited to find ways to create more and more space for this important, meaningful, new way of seeing into my new days.

My reflection to the reading:

Where I’m From (RN)
I’m from coffee tables &
journal lines, cold sun and
strange premonitions,
I’m from unknown motivation,
near failure & forgotten
Anatamoy & Physiology,
I’m from anxiety and
sepsis-training, Roto-prone
beds and hemorrhagic strokes,
I’m from long
nights & longer days,
doctors’ rounds and
curt comments,
I’m from plaits & shaving cream,
poop-stained shoes and
I’m from a long ago test and
a daily drive,
I’m from the bedside
I’ll go to next.

Mindful Gratitude: This Blog in a Book

Two years and two weeks ago, I published the blog post, “The Poetry of the IV,” on this site. In it, I reflected upon the thoughts I was having while placing IVs during shifts in the cardiac cath lab where I worked at the time.

Shortly after the post went live, an author from Ireland named Carmel Sheridan contacted me to see if she might excerpt it in her forthcoming book, a primer about nursing mindfully. After some dialogue, I agreed. Since then, she’d update me on the book’s progress from time to time.

Today, I received an unexpected package from Ireland in the afternoon mail. In it, I found an autographed copy of Carmel’s book, The Mindful Nurse: Using the Power of Mindfulness and Compassion to Help You Thrive in Your Work, along with a beautiful card from Carmel.

My excerpt in Carmel Sheridan’s new book: The Mindful Nurse: Using the Power of Mindfulness and Compassion to Help You Thrive in Your Work. Rivertime Press, 2016. 
As I searched for my excerpt, I enjoyed what I saw. Just this morning, I had strained to think of ways to conjure up mindfulness in the many moments that I found myself feeling impatient; while filling up the watering can to water my plants, waiting for the shower to get warm, standing in line at the store. I was sure I had learned something about finding beauty in these moments, but couldn’t conjure it. As I read her book just now, I saw that many similar moments for mindfulness were outlined alongside practical strategies, and ones to maintain mindfulness in far more complex scenarios, too.

Perhaps my struggle for mindfulness in the mundane today is not much different than the premise I wrote of in this excerpted blog post – I had been inserting many IVs at that point in my career – almost too many. The rote nature of the intake & recovery area of the cath lab that I worked in was getting me itchy. I liked my colleagues and the new kind of setting, but I missed the intricacies of the ICU that I knew so well.

Being mindful with IVs helped me refocus and enjoy my patients and my work – not the skill or task, so to speak, but the connections I was able to work at creating with my patients while inserting them. By seeing past the work and into its elements, I found beauty where I might’ve only felt boredom or frustration.

I am happy to see the paragraph about these connections on one of the pages in Carmel’s book. Looking back, learning to use IVs (and any other skill or task, for that matter) as a moment for laughter, conversation, silent assessment, became one of the most important lessons in mindfulness that my bedside practice has yet to teach me:

Now, IVs are a chance to chat – to talk with patients about where they live, what they do, how they feel. It’s amazing how easy the moments become – even when I miss or blow a vein – if I focus on talking with people. I enjoy myself, the pressure lifts, and I assess through our conversation. Patients bare deep wounds amidst these tiny moments.

Feels great to hold this book in my hands and see my name in it within the chapter, on the reference lists, and in the index. I started this blog as a way to vent as a new graduate – as healing for myself. To think of its contents resting in the hands of others as they read, teach, workshop and grow is a privilege and encouragement.

Check out Carmel’s book, folks – great stuff. You can find it on Amazon, or here:

Year 1 RNs: Learn about [my] stress


This June, I’ll turn 9 as a nurse. In January of 2007, a full six months before my graduation, I landed my first job in the Medical Intensive Care Unit of the largest hospital in our nation’s capital. I started my career on June 25th, 2007 after moving to my first solo apartment in DC with little more than $1000 in my bank account, a pending NCLEX test result, and no idea what I was getting myself into.

Somehow, I managed. I paid my bills, I found my way around a city for the first time, I even acclimated to the Southern cultural ways hidden in DC’s natives. I learned to give bed baths by myself, and to manage the most complex ventilator patients.

On my days off, I felt exhausted, mostly. I wondered why in the world I had enlisted in a career that felt so misunderstood to the public and so wasteful to me. Many days, after long shifts of saving peoples’ lives or helping people die the way they wanted to, I pondered, “What am I doing with my life?” I had no idea that these confused feelings were the result of unprocessed stress.

As I grew in my unit and as a nurse, I began to find my niche, and to find means to make sense of my weighty job. After a patient death that traumatized our entire team, I sought out the bioethicist assigned to our unit and we started a “Moral Distress Journal Club” together. My colleagues and I shared tears and stories over scholarly journals proving to us with numbers and statistics just how hard our work was. People thanked me, and we got better at our end-of-life care together. I also started working on an idea for a pilot study with the nursing research council. I got certified. I started to feel purpose and clarity in my work.

Looking back on that first year,  the thing that I remember the most was my own anxiety and stress. Nobody told me about this at nursing school, or in clinical, or in the incredibly expensive textbooks I was tasked to buy. I was never taught strategies to prepare myself for stress, or how to think about my behaviors while under stress. I just became a nurse, and then for 365 full days after that, I was full-on stressed. This phenomenon echoes throughout the profession, and is solidified by research; old and new.

In my first year, my manager pulled me into her tiny office one afternoon: “The fellow just came to me and told me you yelled at him. What’s up?” It didn’t take long for me to gush my stress to her; I had foolishly signed up for overtime shifts as soon as I finished orientation leaving myself no time to breathe. I knew my words under stress were often misconstrued, and I confessed I had no malicious intent, but no idea how to change, either. “Let’s meet and check-in about this from time to time?” she offered. We did, and mostly, we just talked about things that bothered me at work – processing stress together.

Admitting stress is the first step at managing it, preparing for it. This conversation with my manager helped me move forward, think concretely about stress, and grow. I write about this process in my new column, “Transition to Practice,” in the June 2016 issue of the American Journal of Nursing. Nine years later, I’m happy to help new nurses avoid the stress I felt in year one, giving them tools to meet it as head-on as they do any clinical emergency that they learned how to manage in nursing school.

Special-est of special thanks to Shawn Kennedy and the staff at AJN. Shawn envisioned this column long before I ever knew I had it in me, and her belief in me is surprising and exciting! Check out her inspiring June editorial, Welcoming Our Bright, Shiny New Colleagues.

Special-est of special-est thanks to Victoria Gill, my first and only preceptor. Without her, this column (and my nursing career), wouldn’t be worth writing about.

Existential Tomatoes

I’m splitting a winter CSA share with five neighborhood friends. The share seemed big when we signed up for it, but the last few weeks have been sparse, and I have way too many turnips. Tuesday nights have become kind of weird; we haggle over which of us gets our share’s good items. Tonight’s hotly contested veggies: two jars of dill pickles and two bags of cherry tomatoes.

As we walked home after our veggie gathering, I felt so incredibly un-enthused by what we picked up, and kind of perturbed by our process of splitting the share. Even my friend, the director of the community center that the CSA is distributed from, had joked at us: “Here, have an extra bag of tomatoes to feed the five thousand.”

At the corner where we all usually part ways, a woman approached us and said, “Can you spare something to eat?” Instead of walking past her quickly, as I often do when posed with this question, I offered her a look in my bag. She pawed around a bit, amazed that I only had vegetables, and took the two objects that I had hoped she’d forgo – my jar of pickles, and my bag of tomatoes.

After letting go of my precious dills, as I rounded the corner to my front door, I looked back and caught a glimpse of her. She was chomping away at a mouth full of my organic tomatoes, calling to her friend to wait for her. I chuckled, and liked the sight.

Now I’m home, hungry and lazy about cooking the vegetables that remain, questioning my contribution to this woman’s life. She’ll probably be out there tomorrow asking the same thing. She probably has a million un-diagnosed problems. She will probably stay homeless for many years, if not forever. All of the typical thoughts that usually keep me walking past, swallowing that subliminal guilt with a strong dose of my own rationalization.

I guess I’m no easier on myself when it comes to my writing. Not a day passes when I don’t feel guilty for leaving this site empty of new posts. Not a day passes that I don’t have new ideas for new stories, or ways to finally finish old ones. Not a day passes that I don’t resent my ever-busy life and lack of hours for writing and only writing.

I did not get break the cycle of homelessness that this woman will likely chronically face. But seeing her munching on my random, annoying tomatoes helped me understand something important. I don’t always have to save the world or write for hours every day to do something decent. Sometimes, maybe a bag of tomatoes will do.


New Writing, New Measurements

I‘ve been writing a lot lately – at work, at clinical. I’ve been forcing myself to submit things, too. I’ve long known that my biggest barrier has been my lack of effort. It’s odd — the rejection letters encourage me, because it just feels good to get myself out there. The experiences have been valuable.

Last month, I had a piece published with Pulse, an e-literary journal out of the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine. Working with the editors was fantastic. The piece, which stemmed from a post-ICU-shift draft, blossomed under their guidance, and with it, my understanding of my own voice, and the mind of the reader.

When the piece finally went live, I was sincerely touched by the beautiful response I received on the site. Readers crafted careful and insightful comments, erasing my doubt. Pulse shows no altmetrics – I could not count how many people passed my story on, or how many likes it received. My only measurement came in short, intentional statements of support. As I read them, I felt enriched and supported in my work.

What a contrast, when the story ran again this week on KevinMD, a popular medical social media site. While the story currently has five thousand Facebook shares after just two days on the site, and has bolstered my Twitter following faster than a year’s worth of writing, this success feels different. Distant.

Pulse is a pretty pared down operation. It doesn’t charge for subscriptions, which come in your inbox once a week. It has a very small social media presence – the editor runs a public Facebook group, but posts only seem to come with the Friday evening release of pieces. The site itself isn’t anything exceptional to look at.

And yet, their influence is powerful. It wasn’t via social media that I initially found out about them, after all. The simple line, “This story was first published in Pulse,” caught my eye, at the end of a beautiful, simple, physician narrative in the Washington Post last year.

It’s an interesting comparison, this less-is-more thing. I’m new to being conventionally published, but I do a lot of social media work. It’s thrilling, to watch likes and shares tick upward, and I know I’m not alone when I admit to loving those small, circular notifications that pop up, silently affirming. “Applause,” whether written or clicked, feels great.

Seeing my story on a site as big as KevinMD is an honor, truly. But somehow, the quieter, more intentional audience at Pulse holds a new draw for me, amidst my oft-instantaneous world of e-work. Perhaps it’s because the feedback there infers actual comprehension. Time spent. Care and thought taken, in response to my own care and thought. Other people, reading my story as simply that – my story, not just something their friends will like.

While likes don’t necessarily mean careless reading, and comments don’t necessarily mean the opposite, the successful simplicity that I found in this new audience is refreshing. It makes me want to keep on sending stories out there, just to see who will stumble upon them, and who will sit with them for awhile.