changes

okay, so it is cliche, but we can all agree that the one constant in life is change, yes?

the changes that have been happening to me because of the changes that were manifested (through lots of prayer and conversation with god) and then acted upon, in regards to my career, are changing me in ways that were not fully thought out. i mean, how can you really think through something entirely that hasn’t happened to you yet? some of the changes are very welcome- i feel myself resonating, vibrating, with a much slower, and relaxed energy. the difference between two minutes being too long to wait for something a patient needs and two hours being a fast turnaround for a request. the difference between having to clock in and clock out and being salaried. the difference between chest compressions and a caring conversation.

sure, there are lots of reasons that my new gig is challenging: politics, learning the tactics needed to move a large bureaucracy toward the changes it says it wants, but that all actions suggest otherwise, the inefficiencies of a clinic workflow that have gone unchecked for years. not to mention adding a new specialty area to my repertoire.

and it would be a lie if i said i didn’t miss the OR.

but this new work that i am being called to do, the new spotlight on the areas of my self, of my soul, of the way i walk through the world, it is intense. i feel directed to lean in and do some hard work on how i interact with my environment. to look at the root cause of my impatience, to explore the deepest, darkest parts of my personality and draw those places into the light.

to surrender to the imperfection, acknowledge it, and love it anyway.

and, i think my very favorite consequence of my new job is that i am really sleeping again, dreaming again. when oscar died my sleep left. don’t get me wrong, i still slept “well” because i’ve always been a strong sleeper, but i didn’t dream and explore as much in my sleep as i did before he died. that has been my very favorite change. and one i think comes from my heart being satisfied that i am on the right path.

like my nurse navigator mentor told me yesterday, “you have the heart of a navigator”. that resonates so deeply with me; i feel that. ultimately, it will be my heart that keeps me pushing forward on this new path. and, truly, i would not have the relationship i have now with my heart if i hadn’t spent the last year of my OR career working in open hearts. beyond grateful for my experience in the CVOR.

so, i choose to keep rolling with the changes. learning from life. open to the challenge. baby steps.

last day

I’ve had one other last day in the OR, in 2018, when I left the OR briefly right before Nick died. I made the leap from OR to primary care. As in ambulatory, doctor’s office visit, primary care. I remember really liking it and feeling like it had the potential to be an incredibly powerful platform to reach patients with mental health issues, but then Nick died. He died only several weeks into my transition from OR to primary care. His death by suicide, on the third anniversary of Oscar’s death, which was also by suicide, was more than I could bear and be learning a new specialty area. So back to the OR I went. I was so blessed to have an OR family that welcomed me back with open arms. I hadn’t even been gone for 3 months when I came catapulting back, on the wave of yet another personal trauma and tragedy.

The OR has been home for so long. Over a decade of my life. It felt good to get lost in the rhythm of surgery again. It helped me learn how to walk with the grief of yet another tremendous loss. Still, there was this whisper, this yearning of wanting to do something more, something different, something that would scratch the itch that reared it’s ugly head the moment that I understood Oscar was dead. I explored so many different options. Countless resume submissions to all manner of different fields in nursing: school nursing, occupational/ employee health nursing, case management, I even applied for a floor nursing position at one point when I was exploring the idea of being a nurse educator! I applied at colleges to teach, to be on public health think tanks. Zero of these ever came back with positive outcomes- I never got interviews. These serial application cycles would happen about every 6 months to a year from the time that Oscar died. It was sort of exhausting, but I felt led to do it. To get out into the job market about every 6 months or so and see what other avenues of nursing I might call home, a position that would utilize this new set of skills that I had learned related to overwhelming grief and our experience getting lost in the system. Often, when I look back at our experience the few months before Oscar died, hindsight being what it is, I see how incredibly perfectly all the holes in our slices of Swiss cheese lined up. And Oscar fell right through. Unfortunately our outcome was the worst, death.

A sort of breaking point for me was when I didn’t get promoted past boardrunner/ charge nurse in the OR that had welcomed me back with open arms after Nick died. I wanted to lead that department with such a deep desire, but my director didn’t think I was ready. So, when I didn’t get hired as the OR manager in that department, I decided it was time to do something that I had always wanted to do in surgery: open hearts. I researched programs in our local region. St. Luke’s Mid-America Heart Institute was the only choice hands down. I applied. Was offered a job. And I turned it down the first time because I was SCARED! 3 months went by, I was incredibly stressed and stretched to my limit working 12 hour shifts 3 days a week as boardrunner/ charge nurse for an OR that ran 12 starts daily with, more times than not, 50+ cases. We would be balls to the walls busy from 7am to 7pm (and after) more often than not. When I finished my BSN program at the end of 2019 I applied to the CVOR (cardiovascular operating room) at Luke’s again. Immediately got an interview. Second time around I accepted. Time to face the fear and trust the process; embrace the lifestyle of CVOR nurse.

My time in the CVOR over the past year has been an incredible learning journey. I have learned this amazing specialty. I have learned a lot more about my own limits. I have learned what I really want to focus on in patient care. That has been the most exciting. I have been pushed to learn more about myself as a nurse and what really makes me tick. What makes me excited about what I do and more convinced than ever that I have been called to this profession. I feel, more than ever, that I was made by Him to be a nurse. And just how important my voice as a strong nurse is to the patient care TEAM. The team isn’t just docs. It isn’t just nurses, or techs. It is all of us, each one with a different way of seeing the patient’s experience. I did my best in the CVOR. I learned how to really pray, each call shift stretching me to my personal limits in handling stress in a healthy manner. I participated in some of the most incredible, and life-saving, patient care of my career. I learned to understand how to monitor critical patients and what it really means to have someone’s life in my hands. I will never, ever regret my time in CV surgery. In fact, I believe without any doubt that my time in the CVOR is what opened doors to me to my forever career path: patient navigation.

There were so many conversations I had with the staff in the CVOR that helped me to find my place. From my manager, to my charge nurse, to my fellow staff nurses and techs, to the nurse liaison for our department, to the docs, to the physician assistants, to the anesthesia providers, to the perfusionists. Every single person was open and receptive to me exploring life outside of our department. That meant so much to me. It says a lot about the overall culture at St. Luke’s and why I am so incredibly blessed and proud to be a St. Luke’s nurse. I started keeping an eye on the job site at Luke’s in the fall of 2020. I applied for case management positions and a nurse resource position. No bites. I decided to fully commit to the OR and give my all in my current specialty so I applied to test for my CNOR (certified nurse operating room) certification and began studying OR standards and guidelines. I became involved in a system-wide committee to standardize our malignant hyperthermia preparation and response. All the while keeping an eye on jobs at Luke’s. That was the one thing I was sure of: I wanted to stay with Luke’s.

I first noticed the Thoracic Center Patient Navigator position a month before I applied for it. I stalled that long because I had seriously just made the commitment to stay in the OR and I was insecure because I had already been passed over for case management positions. This position kept coming up for me, though, because it was posted under education and the job description sounded exactly like what I wanted to do. It would incorporate my communication and leadership skills and also grow my coaching and education skills along with challenge me to develop a new role for the center. And, I was fairly certain it would build on my relationships that I had already established with some of our cardio-thoracic surgeons. The thing that finally pushed me to apply was a conversation I had with my child, Viv. They got real with me and that made me realize that it was really time to get serious about changing my work lifestyle. I needed to dial down the stress and uncertainty and dial up the consistency. So I finally applied. Had an incredible journey to my job offer and just finished my second week in the clinic as the Thoracic Center’s new Patient Care Navigator.

This change in my career path has been a long time coming. I feel more certain with each day that I have made the right choice and that I do, indeed, have something really special to offer patients. With my combined professional and personal history, my ability to grow through post traumatic stress, along with my ability to communicate clearly, succinctly and efficiently, interwoven and enhanced by the amazing Thoracic staff and our doc champions that keep the clinic humming, I have faith and hope that we will be able to build an amazing, world-class Thoracic Navigation program at St. Luke’s.

Oh, and did I mention I start my MSN in Care Coordination at Nebraska Methodist College in August?!

This is going to be fun! 😉

more than ever

more than ever i feel myself settling into a rhythm with life.

my rhythm feels at it’s base a strong flow of gratitude. i am so fortunate to have the career i have always dreamed of. i get to use my skills to help a patient population that is in critical need. this year i finally came to terms with the panicky feeling i get when i have been at a job in the operating room for any amount of time since oscar died.

the first time i felt the panic i am talking about is the day he was cremated. i remember the day in bits and pieces. i signed the waiver so i could push the button to send his casket, his wooden box that held his body and some beautiful wildflowers, into the oven that would burn his body to ashes.

i was alone in the little adjoining waiting room. pierce and grady waited outside for this part to be over. they make you sign a waiver because it can destroy you to watch your loved one’s body travel into an oven to be burned to ashes. the only other person that witnessed this event was the nice man who ran the crematorium. he positioned himself into a quiet corner where i couldn’t see him very well so i could take the time i needed to push that button. you’d think i would remember what the button looked like, but i don’t. i do remember singing. i sang oscar his death song and i pushed the button and sang and sang and sent every ounce of positive energy i could into that room. i watched his casket, his wooden box, go into the oven through the window that separated me from him inside his box. and the nice man closed the oven door.

after oscar’s box was in the oven with the door closed, pierce and grady rejoined me in the little waiting room that adjoined the oven room. we sat in the little waiting room the full 4 hours or so that it took for his body to burn to ash. grady and pierce played cards. that day started pierce’s card collection. i did so well. i was so strong. and then when we got home i fell apart. i couldn’t keep it together. i felt an indescribable, absolute terror. my boy was gone. he was gone. gone, gone, gone. i remember grady saying something like of course you feel panic, your boy is gone. and that is the root of the panic that i have felt at every job i have had in the o.r. since oscar died.

i didn’t fully realize it though, that feeling being the reason that i always want to run from what i have always wanted to do: be an o.r. nurse. i fully believed the feeling was because i needed to be more involved in mental health. through conversation with my colleagues, my dad, prayer, journaling, and simply sitting with the evidence of my patterns of behavior i made a major break through this year. the reason that my path out of the o.r. has always been blocked is because i am absolutely, 100%, meant to be an o.r. nurse. and the reason i always try to run is because i haven’t integrated the panic from the day of oscar’s cremation into my long-term memory from my survival brain.

oscar’s ashes in his beautiful earth-friendly bamboo urn; his dad picked white roses

my path has taken me over so much ground. to finally be working in cardiovascular surgery, after a long, and successful, foundation in main o.r. is the first part of my professional dream realized. discerning that the panic i felt and the equivalent need i have assigned to it as being a reason for leaving behind a professional achievement would not have been possible if it wasn’t for my current work family. they have all been so patient with me!

so, as i have been integrating this feeling, this memory, with the simple and graceful tool that my amazing psychologist taught me in our earliest days working together (that’s almost 4 years now!) i have been able to steadily put this panic to rest. every time that i feel it i acknowledge it: i know you, you are the panic i feel because i had to cremate my son’s body; then i reassure it: of course you feel that way, your son’s body is no more, of course you feel panicky terror. and it settles. slowly, it settles. i have worked through all of my ptsd catalysts this way: the color white, the smell of formalin, the list goes on.

me at work right before oscar died in 2015, loving the main o.r. at k.u.

and i can open my life to new goals! next up, msn with a focus on education. being an educator has been in my blood since i became a nurse. fits me to a t. i plan to start back to school the fall of 2021.

another part of my gratitude is that if my son had to die, and he did, unfortunately, because a disease process took hold of his brain and killed him, i was able to fully experience every piece of his after-death process. i wasn’t rushed through anything, i didn’t have to worry that the funeral home would be too busy to take care of us. i was able to have a full memorial service for him and not worry that too many people would be there to properly social distance.

i feel the collective grief happening today related to the pandemic. i feel, deeply, the sadness running through our world. even though i understand the process of out-of-order death, i am grateful that i do not understand it with the limitations of our society today.

may god bless all who feel the sting of new death today. may god hold each and every one of their hearts and bring them some semblance of comfort, enough to make it through the next moment. and may each moment stack on another moment to make minutes, hours, days, weeks, months, years.

too long

THERE IS SO MUCH!!

It has been way too long since I have written. I feel like I have been through at least two lifetimes in the past few months. My new job is pushing me to grow in ways I didn’t realize I needed to grow. It is interesting, as I have been adjusting to my new unit and the culture there, I have been turning inward. I have been reluctant to share my inner journey with you, which had become such a big part of who I was and what I needed to do to stay healthy before my transition to the CVOR.

After my therapy yesterday with my treasured psychologist it became very clear to me that I need to reach inside and determine what I need to do to stay healthy and then do those things. I need to fiercely guard the time I need to do those things. I am saying that as if it is some incredible realization when really it is a well-known fact, the problem is simply that if I spend too much time away from what I need to do to keep myself healthy my grief comes out sideways.

This is what I have been doing too much lately and not paying attention to myself because of: healing my relationship with Grant. There, I said it. Well, not to mention Covid-19 (learning how to live the new normal with the rest of the planet). Grant always pushes me to be so quiet about what we have going on with each other, and I get it, he enjoys privacy, but I am not a quiet person when it comes to my life. I like for things to be out in the open. Transparent.

I lived a long time in the dark during my youth. I really had two lives then: the life on the outside that looked mostly okay to everyone looking in on us (the mask) and the one at home that was full of anger, alcohol, and marijuana with an abusive husband who had me convinced if I tried to get help for my addiction he would lose his job. Back then I was just trying to keep it together enough to get through school and maintain a job. I have started a writing exercise that my psychologist recommended might help me integrate those traumatic memories. It takes so much emotional energy to do it I can only face it in small bits.

Right now Grant and I have reached a point where we want to live together again but there are some major issues that need to be figured out. The first is that I get virtually zero alone time when we spend a lot of time together. This is because Phoenix prefers my care to Grant’s care when the two of us are together. I have been encouraging Grant to try being more assertive and maybe that will help if I also stop stepping up right away. This kind of change takes time when you are working on this sort of reintegration. Another issue is that we do need couples counseling. And, of course, we seem to be attracted to completely different types of therapists. Of course. Another big issue is our motivation: are we doing this because we are in love with each other or are we doing it for Phoenix?

Another big issue that Grant and I have is our reluctance to share our journey with our friends and family.

I can only speak for myself here, but I feel like we have been through so much and reached such a very low point together that our friends and family were very happy and relieved to see us separate when we did. I mean we went through the whole deal for a proper separation with lawyers and parenting plans and all of it.

Since I started working in the CVOR I have changed in ways I didn’t predict. I have been through some major ups and downs during my transition to my new unit and I finally have started to feel like I am finding my place. This is great because for a few days there I thought I had made a big mistake! One of the things that has come out of my experience caring for this patient population is a renewed and deepened Christian faith.

This is an issue for Grant because he does not vibe with Christianity. He also tells me that he doesn’t think I will maintain my Christian faith for long. I have tried explaining that this has been a lifelong dance and I have finally reached a point where I am comfortable in it and so I am feeling the strength to own it and ground myself in it like I never have before. This will be a sort of living amends for me to Jesus. And time will tell. I will say that a very beautiful realization and discovery has come from my renewed faith: chaplaincy. Becoming a healthcare chaplain as my long-term career goal makes sense and every time I think about it I feel deep peace.

All of this and the churning of difficult times of the year for my grieving soul: Mother’s Day, Pierce’s birthday, Father’s Day, Vivian’s birthday, Phoenix’s birthday, and on Friday, Nick’s birthday.

Here is the good news: Grant and I settled on him not moving in for at least six more months and I am refocusing on my alone time. I think it is best for us to honor our parenting plan and spend time alone together on dates. Certainly, plan time to spend together with Phoenix and my Lane kids as a family, too, but mostly focus on alone time getting to know each other more intimately. No more spending time together like we are living together. There are too many unhealed hurts and I need to spend time alone doing things like writing updates to my blog.

No more hiding.

 

Long time coming

In December I finished my BSN. What a relief. I showed up to the  Avila University Administration Building to pick up my diploma the day campus re-opened after Xmess break and when the nice lady behind the counter handed it to me and asked me to check the spelling of my name to make sure it was correct the tears started flowing. Joy, sadness, relief, pride. It was all in those tears. And the missing. Missing Oscar, missing Nick. I can hear Nick telling me how proud he is of me. I can feel Oscar’s arms around me squeezing me tight in hugs only he could give. Thinking of that moment brings the tears to my eyes and goosebumps to my flesh even now.

My life seems to have been moving a million miles an hour for the past several years. Really since I got clean eight years ago. Change is always constant. Not just subtle changes like needing to change the brand of your coffee because the one that you like has gotten too pricey or your usual store has stopped carrying it. My changes have been life or death, literally. Navigating big change is hard. Nothing easy about it. I have found that the way to stay (mostly) productive is to focus on the small bits that make up the everyday. Breathing. Breathing is a big deal for me. Meditation daily is part of my routine, but it hasn’t always been. At first, it was simply remembering to take deep cleansing breaths whenever the uncomfortable vibrations of emotional pain would start creeping in. Then drinking enough water. For real. Water is a big deal. After that comes nourishing foods. All with a focus on mindfulness. Staying square in the middle of the moment you are in.

In the last semester of my BSN, I had a realization. The truth of my realization is that I am a nurse whose calling is surgery. This has been a difficult truth for me to embrace since Oscar’s death.

I studied mental health- depression, and suicidality- for all of my individual projects while completing my BSN. How confusing to study mental health so intensely if your calling is surgery. I thought for a while that I should try to change my specialty area and I did for about three months beginning in the late summer of 2018. I worked in primary care for those three months and I learned very quickly that it wasn’t for me. Nick died in September of that year and I couldn’t try to make the transition to primary care work any longer. Thankfully, I was welcomed back to the OR at Menorah I had been working in since I left KU in 2016. It was really good to go back to surgery after trying something different. This was a big clue to me that my calling is truly surgery.

Fast forward to last summer, 2019. It became glaringly clear to me that Menorah was no longer a good fit for me. Not because I was grating with personalities or anything like that. Menorah OR has been a wonderful family for me. I love all of the staff there dearly and it took me over six months to make the final decision to leave for another OR. I was not aligning with the foundational ethics of HCA. Over and over again I would see the same problems happening and I was powerless to do anything about it. I had ended up back in a board running position and was denied the opportunity to advance to management, so I was in this strange and very uncomfortable position of seeing exactly what needed to change to make our department more efficient and safer for staff and patients with no power to make change happen.

I applied for other OR staff nurse positions after I was denied the promotion to OR Manager at Menorah- and I turned down two very strong offers from organizations with very positive reputations. I wasn’t sure if my motivation to leave Menorah was coming from a place that was purely emotionally reactionary. What if this just meant that I really did need to change my specialty area? That was the lingering question. I felt like I wanted to try a little longer at Menorah (and finish my BSN). Ensure that I was truly doing everything I could to continue my career at Menorah. There were several conversations with my director about burning out in my board running position. That it was too stressful to make an impossible schedule run smoothly every day. What we needed to change to make our department more efficient. My concerns fell on deaf ears. I tried at Menorah. I really did.

I explored the question of whether I was really meant for surgery because of all of the heart and soul that I gave to Menorah with no reciprocation. I decided to apply for any and every job that sounded interesting to me that wasn’t in surgery. Looking back I feel like I was testing God. My job hunt included many different community health type positions from school nurse to county emergency coordinator to public health. I applied at UMKC, Cerner, Johnson County, Shawnee Mission School District, even Tyson Foods! ZERO interest from these employers. My resume went nowhere.

Swirling in the back of my mind, the entire time since I had turned the offer down in September, I kept thinking of one OR staff nurse position in particular: CVOR at Saint Luke’s Hospital. When I had interviewed there in late summer last year I was so impressed. I asked the manager more questions than she asked me. All of her answers were spot on. I shadowed there and was completely enthralled. The way the nurses practiced, the care I saw given, it was all world-class. Truly world-class. And the cases themselves! I had always had a little piece of me that wanted to learn CVOR, but I felt like I wasn’t good enough.

I had first been exposed to CVOR at KU. One of our robot rooms for main was in the CVOR and I would peek in the windows of those heart cases and I remember saying to my work wife at the time how much I wish I could just be a fly on the wall in those rooms. What if I was meant to grow as an OR nurse in a way that I never thought I would have the opportunity to? What if I could grow my OR nursing practice to include this pinnacle of OR nursing knowledge- open hearts? Those were the questions that began to make themselves regulars as I would contemplate my next career move.

The day after I finished my BSN course work in December 2019 I looked to see if the position at Saint Luke’s CVOR was still open. It was! I immediately reached out to the manager and to the HR recruiter I had worked with previously. I went through another round of interviews. I felt a sense of home during those interviews. I was extended a second offer that I accepted.

I have been in my new position learning the rooms as a CVOR staff nurse for about a month now. I’m not going to lie, it was pretty rough at first. The cases are the highest acuity and that is challenging to me because of my own personal trauma, but I feel confident that I am able to process these new experiences appropriately and bring my highest level of professional performance to the table. Also, fitting in with such a tight-knit team… They are the tightest-knit team I have ever seen, and each and every one of them holds each other to the highest practice standard. And me, coming from a leadership position where I had been on the outside of staff camaraderie- I am sure it seemed like I was either super stand-offish or a snob. Transitions have always been hard for me, but I feel like especially over the past two weeks or so I have started figuring out my spot on this team. I feel like I have so much to learn even though I have been an OR nurse for the better part of ten years. This specialty area should not see me bored for a very very long time, if ever!

I have been feeling so much of myself change since I started at Luke’s. The organizational atmosphere at Saint Luke’s is amazing. I have never felt so supported in my nursing practice. What I have had the blessing to witness caring for our patients is truly humbling. Somehow being with these patients is different than all of the other surgical patients I have cared for. It has been very powerful for me on the deepest level of spirit.

My career finally feels like it is exactly where it needs to be. And that has been a long time coming. My new understanding is that I can pursue the career that I have always dreamed of and simultaneously honor my firstborn son, Oscar. I don’t need to fundamentally change what has always excited me about nursing in order to fully honor his memory. The way that I carry myself as I do the work that I love is what matters. That I keep talking and keep sharing openly and honestly about my experience and all that I have learned about mental wellness is the purest way for me to honor my beautiful boy, Oscar.

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