Finding Your Niche

Today I am going out to UMass Amherst to address the second bachelor students. I went and spoke to the undergrad nursing class in January and it was a huge success. What am I going to talk about? I'm going to talk about figuring out what kind of nurse you are, and creating a role for yourself in the world that fits that person.

My involvement in coming to speak to the school of nursing is the stuff of fairy tales for me. I was well known in the School of Nursing, and mostly well liked. However, since I was not a traditional nursing student, not many of my professors expected I would become a nurse.  In fact, when I graduated, they didn't read off a hospital after my name, which is what typically happens.
 "J. Jones, Cooley Dickinson, Northampton, Ma.  A. Morrison, Children's Hospital, Boston."

For me they read, "M.Whitaker... (loooong pause) will be... will be performing at Improv Asylum in Boston," because I had just made the NXT cast and that's what I wrote on my graduation information sheet.

So when they invited me back to speak to young impressionable students... that amazed me. It still amazes me.  I always fantasized I would have a chance to tell my story to people it might matter to. And now I am being given that chance.

Nursing school was difficult. Not because I wasn't great at memorization, cramming, or writing 20 page papers the night before they were due. Boston Latin School taught me all that a long time ago.

No, nursing was difficult because I was trapped between two worlds. Comedy and Nursing. Theater and Medicine. Art and Pragmatism. Doing both made sense to me, but it made little sense to many of my professors.

In fact, I had one clinical instructor who, on a weekly basis would take me aside and ask if I had quit Mission:IMPROVable yet. I hadn't. I had been in the group for four years before she met me, I explained. I planned on doing improv professionally later on, I told her. And so long as it didn't effect my grades, it was really none of her business. Even as I pulled in a steady line of "A"s on my papers, tests and care plans these little side bars continued because "comedy just isn't an appropriate hobby for a nurse."

This is what I looked like sophomore year of Nursing School.
I wouldn't have placed bets on me getting an RN either.

Meanwhile, I was fighting some personal battles. My father had passed away at the beginning of sophomore year and my mother was/ is unable to work. I was newly financially responsible but couldn't qualify for aid because they assuming my mom could throw some of Dad's pension my way, which she couldn't actually afford to do. So I had taken out a loan and was working as hard as I could without quitting improv. Often I was coming to school not having slept at all because I had to work overnight shifts to make money.

One morning, my white sneakers split in half after being on my feet all night. The next morning I pulled on my green high tops and went to my clinical in West Springfield where I was shadowing a school nurse at a local high school. We had been working together for a few weeks and she had already commented that I could relax the school uniform so I went in and everything was fine. The next week I still hadn't replaced the shoes because I needed to wait for my next paycheck. Unfortunately, this was the day my UMass clinical instructor decided to visit me at the clinical site. She took me into the back room, where we let girls who say they have cramps lie down when they want to skip gym.

I stared a a poster on the wall of "100 Things To Do Instead of Smoking," and listened as my instructor told me that I was the reason people don't take nurses seriously. I thought about all the nurses in the world wearing teddy bear scrub tops and tried not to open my mouth. She told me the next time I came in I better have white shoes. I told her the truth. That I couldn't afford them right now.

"Don't you have parents?" she asked.
"I have one," I answered, daring her to go further. Which she did.

A verbal fight ensued. In the end, I won. But not before some terrible things were said on both sides. She insulted my family. I threatened to take it to the Dean. I'm amazed she passed me that semester. But she did. Green high tops, sassy back-talk and all.

Those stories are just two examples. There were a million reasons I hated nursing. I wanted to quit, but I have never been a quitter. I have never walked away from something just because it's hard.  I was good at the technical skills, and I got good grades on every care plan. The only thing that was hard, it seemed, was being accepted by other nurses. I just didn't fit in. Maybe it was enough, I thought, just to know I could have gone into nursing. 

The person who finally got through to me was Jennifer Foster. She taught Culture and Anthropology. She had traveled the whole world. She wore funky clothes.  When I mentioned to her that I was probably leaving the school of nursing she listened carefully and then said simply, "don't."  I'm paraphrasing here but she told me, "you don't hate nursing. You hate the culture of nursing school. When you leave here you choose what you want to do, and the people you will do it with. You will find your niche. The nursing world needs more nurses who are like you. Because only you will fill that niche. Don't forget that."

I didn't forget that.

When I spoke to the students last winter I told them that one of the most important things they could do for themselves was remember that they are free to NOT take advice. They do not have to listen to people who tell them to quit something they love. By the same token, they also do not have to listen to me.

 Everyone on my path was trying to do something good for me. The woman who hated comedy wanted me to be a successful (and published) psych nurse. She was giving me advice from that lens. The woman who hated my shoes wanted me to be taken seriously, and she was worried I wouldn't be. It made her say some very mean things, but it had originated from a helpful place. But I was free to politely disagree with them. As soon as you figure out that you are free to NOT take advice, life gets a lot easier. It really frees you up to set goals and then systematically pursue them. Or you know, float through life on whimsy like I do, accidentally landing both my dream jobs in one year. Whatever works for you.

I received a lot of emails afterwards thanking me. A lot of students said they were glad someone had the courage to say the things I said. Some of them said they also had been thinking about quitting because they don't feel like they fit the "nursing mold."  They felt better now. I felt better too. Telling all the stories about nursing school helped me let go of my anger.

So, I found my Niche. Obviously. But the thing about Niches is that, sometimes they change too. If they didn't I'd still be teaching theater at a Montessori. That was perfect for a while, but then it wasn't anymore.  I'm going to add that to my speech today.  You have to continue to be aware of yourself, reevaluate your goals and your dreams and then keep carving away at your place in the world. Because for a room full of intelligent, dedicated, passionate people there's absolutely no excuse not to do what you love.

Not The Doctor

Patient: Why can't I have Flexeril? It's all just pain medication.
RN: Not really. See, Flexeril works in the brain stem and sends signals to your muscles to unclench. You told me your head hurts, which is probably not due to muscle spasms.  Tylenol stops your cells from creating these things called prostaglandins. Prostaglandins are protective, your body forms them when there's a problem, but they also cause pain. By stopping them from being created, Tylenol reverses the pain you feel. Like in a headache.
Patient: You're not a doctor.
RN:  You're right. I'm a nurse.

(stare down)

Patient: I think I'm having a muscle spasm now. Can I have my flexeril?
RN: (sigh).

What Was That Sound?

I can't believe I dropped the pill.

I am furious.

There is nothing else in this moment besides my fury, because a patient needs that pill and I knocked the medicine cup over and I can't find  that pill and it was the last pill in the bottle and the pharmacy is down
                                                                                                                                                           two  

floors

and the elevator is soooooo slllllooooooow and I have had to pee for over an hour but I have not been given the chance to pee because I have been movingnonstop since the shift started.  I am starting to sweat. The hallway is one million degrees. Where the hell is that pill?

I am on the ground, and hidden behind a row of cabinets but above me I can hear the chaos in the hallway. A patient near the elevator bank is demanding to see a case manager. A call bell rings, coinciding with a phone. The bells are discordant. The coffee pot is broken and sounds like a vacuum cleaner choking on a piece of carpet.  Mentally I am ticking off at least four other things I need to prioritize before I can leave the unit to visit the rest room. And the highest priority is THIS PILL which I can't find. So do I go to pharmacy now and skip the other three tasks until this one is completed? Or do I move the other three tasks up the queue before leaving the floor to get a replacement for THIS STUPID LITTLE TINY PILL that is so important. So very important  and I am a dumb, dumb idiot for spilling the cup.

"Excuse me." There is a patient peering over the cabinet at me.  I know him very well.

"Can you open this can?"

He gently lowers the soft drink can onto the counter top using his wrists. I stand and smile before popping the tab and helping him put the can back between his wrists.

"I had good luck today," he says smiling, "I put my money in the machine and instead of just one ginger ale, I got two!"

"I love when that happens!" I say, genuinely. Because, who doesn't love that?

"Well, something was meant to go right!"  

He walks away, can between his wrists, earnestly pleased at his good fortune. Because he may not have use of his hands but he has two sodas. In fact, he may never be able to use his fingers again, but he is practically whistling down the hallway because he found something positive to latch onto this morning.
 And amongst all the other sounds in the hallway I thought I could hear a new one. It was the sound of my own heart breaking.

 I found the pill. And the patients all got their medications. And everything got quiet. And I went to the restroom. And in his bed by the window, a thin man in mismatched pajamas sipped ginger ale through a very long straw and smiled serenely at his fortune.

Navigating the Labyrinth

Why is so much of the health care system set up for consumer failure?

My doctor referred me to see another doctor. She made an e-referral, "shared" my e- Medical records, and told me all I had to do was set up an appointment. Technology is great, I thought happily. I had no idea that I was about to enter the scheduling Twilight Zone.
Consider this sentence in a message left on my voice-mail hours after I initially called to set up an appointment:

 "Then we'll mail you a questionnaire and when you fill it out and mail it back we will review it and then call you to make an appointment. So call back and let me know if I should send it."

First of all, you'll mail a what?  I'm not taking the Pepsi Challenge. I'm going to see a doctor. Second of all, I had already called and left a message in the "scheduling" box. Which I was only allowed to do after I did an intake over the phone with someone from Registration. Clearly, I want an appointment. Send the questionnaire if that's a real thing. Why do I need to call back a third time?

Surely I had misunderstood the voice-mail.

The next day when I called I was told the questionnaire had not even been sent to me yet since they had not heard from me. I asked  why I needed to fill out a questionnaire and was told "so we can determine which practitioner you should see." At this point I reiterated that my doctor had submitted a referral for a specific doctor in their practice. "That is the practitioner I should see," I pointed out. The secretary told me I still needed to answer the questions and mail it back. There is no way to fill out the form online. I need to receive it, fill it out, mail it back, and wait for it to be reviewed before I can schedule an appointment.

This is insanity to me. In an age where robots perform surgeries,  where computers can play Jeopardy,  and where I can have ice cream delivered to my door UNTIL 4AM and pay for it with a credit card, why am I watching my mailbox? Don't they know I am rarely home? That I have two jobs? That I just ran out of stamps? Am I being referred to see Dr. Quinn, Medicine Woman? *

As I stood in the hallway at work, trying to let the anger go,  it made me think of my patients.

- If I can barely navigate this ridiculous back and forth of voice mails, phone calls and paperwork, how hard must it be for someone without a home? A phone? A voice mailbox? A mail box?   Even if a homeless man or woman has a mailing address (and many do), often it is not accessible  to them 24/7.
- Add on the fact that seeking help for anything other than acute injury is not going to be a priority for someone on the street, and you have a real barrier to compliance for appointments related to chronic life threatening problems such as diabetes, cancer and AIDs.
- Forget appointments to screen for early signs of disease, such as yearly pap smears for females or colonoscopies for people over the age of 50.
- Plus, when I finally get an appointment I am likely to write it down somewhere, be able to take a (paid) day off from my job and I will drive my car to see the doctor. A homeless man or woman is likely to forget the appointment, or just blow it off due to lack of transportation or the need to be somewhere else at that time  (taking care of an infant, standing in line for a bed or food) or in some sad cases, abusing substances to mask physical or emotional pain).

That's why Healthcare For the Homeless programs are so important nation-wide. It's not about cheaper access to services or free care. It's about access to services at all. It's about organizations that can offer rides to the disabled war veterans to get to appointments, or who will help an illiterate woman  fill out pages and pages of complicated forms in order to get social security benefits. It's about teams of people who will meet with folks who have been through too much trauma to deal with the type of rejection sometimes faced by patients waiting for care. Just think, I've had to call this woman's office three times so far since my PCP made the referral for me. People with mental health issues, social phobias and histories of being abused probably would not have made the second call, if they made the first one at all.

So as I continue to try to get in touch with Dr. Mike** I am thankful for the structures in place in my life that I often take for granted that will assist in me eventually getting an appointment. And I vow, not for the first time, to do my best every day to address every patient issue that I can, or to put the patient in direct touch with someone who can help them. It can't always happen. Things get busy. Patients get blown off. Especially ones with minor complaints. We triage, we prioritize. But I can try my best.
Because unless I create the care I wish to receive, the system is going to stay broken.

In the meantime, Nurse Sassy Lionheart suggested I just get on my horse and gallop the questionnaire back to the office. You know, to speed things up.

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* Gosh I hope so. And I hope Sully is there. mmmm.. Joe Lando circa 1996.. That helps. No more anger. Only wild and free "courtship feelings." ****
**  Not her real name, obv, but I am assuming she, like the real Dr. Mike, will be bold, outspoken and have all kind of new ideas she learned at the Women's Medical College of Pennsylvania.***
*** If not, this was so not worth it.
**** No disrespect, of course, to Joe Lando's current wife and children. I am glad it worked out for you all.

Flattery Going Nowhere

Sassy Lionheart: That's the patient that called Night Nurse No Nonsense 'exquisite.'

Me: Wait what?

Sassy: Yeah, he told her she was exquisite and asked her name.

Me: Ha! You know what he said to me?

Sassy: What?

Me: He told me if it weren't for my stethoscope he would have thought I was a patient.

Sassy: Ha! What did you say?

Me: That we don't have a pediatric department. Do you think he meant I look sick or... homeless?

Nurse Bestie: Your hair is a bit -

Me: Enough.

Blizzards of Blaverly Blace

Supervisor: "Thanks for coming in and helping."
Me: "I'm going to build a snowman with the patients before I go, ok?"
Supervisor: "Sure, have fun."
Me: "Don't worry, I'm not going to put it on my time sheet."
Supervisor: "Oh no, you should. Mark it down as 'bereavement.'"

Baby, RN

This past year I had the challenge and privilege of working closely with the palliative care team at work.
This fall I have faced two deaths in my own family within three weeks.

(Hang tight guys, this blog is about to get reeeeeeal.)

Something that really struck me during this time of grief for my family, was how my role within my family has changed in the past few years. Not only have I had to re-connect with some of my more distant relatives as an adult, as opposed to the child that they remember; now I am also a medical professional.

"I get it, and my daughter - she's a nurse, she understands too," my mother whispered to a tired-eyed RN last weekend. "It's just.. well, be prepared for my aunt to have some... questions. I've been trying to explain things. But can be... difficult."   "Difficult" is the word she settles on, with good reason.

 Never have I been introduced as a nurse (outside of work) so often. Never have I tried try to see my family through the eyes of a hospital staff.  I've settled on these generalizations:

Older Pompeos believe:
Illnesses are mysteries never to be solved, death is not to be discussed, and Doctors are Gods.

Older Paoluccios believe:
Illnesses are weakness never to be revealed, death is not to be discussed, and Doctors are Making Mistakes.

And here I am.
The family's favorite little actress/comedian/writer/photographer and now, three years a BSN, RN.

Fielding questions about medications. De-coding doctor's orders. Interpreting instructions. Wishing I could convince my family that Hospice doesn't mean  killing someone. Wishing I could encourage my aunts to ask the doctors questions. Wishing I could discouraging them from picking fights with the visiting nurses.

Silently holding hands at bedsides, leaving to buy everyone a cup of coffee, trying to just be family. Trying to appear intelligent. Trying not to meddle. Trying not to make jokes, for the love of God, Misch don't get nervous and start to make jokes. Save it for the show.

My mother, my ally, who was in the health care field for years, does her best to smooth things over. She is the link between them and me. They've had a longer time to get used to her being a grown up, after all. She has two children of her own, after all. You'd think-

"You're picking on me," she complains to her Uncle Frank when he calls her bedside advice "redundant."
"You're an easy target," he rasps with a smile.  She sighs and shrugs at me, then smiles. She's given up for the moment. She'll be the niece for now. It's easier than being the nurse.

Later, when the hospice nurse explains some of the signs of end of life to us, I just nod. I don't explain that I know already. I don't explain that sometimes it's been me running down the list of things to expect, trying to prepare the respite aides and nursing students serving at the bedside of their first palliative care patient.

I just nod. I nod to let her know I am on her side. That we will try to make this death as dignified and peaceful as we can. Because sometimes you're a nurse. And sometimes you're family. And from now on, I am always both.

Free Public Flu Clinics

Boston Health Care for the Homeless will be holding 2 public flu clinics over the next two weeks.  These clinics are open to everyone including patients, staff, volunteers, shelter staff, and family and friends.

(That means you guys!!)

So on your lunch break come visit me at work, get a flu shot, and bring me some coffee.*

Wednesday, 11/10: 10am-7pm at JYP in the main lobby. (That's tomorrow!)

Tuesday, 11/16: 10am-7pm at JYP in the main lobby. (A week from today!)

Jean Yawkey Place (JYP), the home of BHCHP is located at 750 Albany Street, Boston MA

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*Just kidding. Just bring a smile and your sweet supple deltoid ripe for the vaccinating.**
** Although if you wanted to bring me coffee I would never refuse it.

Where is MischMash?

Honestly, everyone, the real reason I haven't been updating is because this game of Assassins just got so intense for the past week that I have been too busy to write.

How am I supposed to write when I need to be hiding in the backseat of old cars in the North End wearing a Boy George wig?

Last night in an epic show of brute strength my assassin assassinated me, in front of a crowd of seriously useless bystanders.

Some of my friends thanked my assassin because now they can go places with me this weekend without me acting delusional - pointing my water gun at bushes when exiting or entering a building, wearing disguises, obsessively checking over my shoulder at all time et cetera et cetera.

The minute I locked eyes with my assassin was one of the strangest moments of my life. And I do realize I am still talking about a made up game here. Still, for a week straight I had been imagining this person everywhere, and then THERE THEY WERE. I was expecting the moment to come, and it did and it felt like the moment when you're in a nightmare and you realize you're in the nightmare and you know what comes next and you can't stop it. I slapped this person after I got sprayed, that's how shocked I was.

Anyway. Back to my real grown up life now. Have I mentioned yet that I am the wound care nurse at work now? Just while our real wound care nurse is on leave. But still. Wound Care. It's one of my favorite things to do, and I get to dedicate eight hours of my time to it every Tuesday.

Time to put away my water gun and pick up my 35 cc syringe with 18 g needle attached.*

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* I'm a better aim with the syringe anyway. Wound care jokes!

spell sheck

Yet another good reason to double check all my notes before I sign them electronically at work.

This time I (almost) documented that a patient told me:

"I alway shave blurred bison."

or is this how you know you're a nurse?

Walking down the hallway, it's only 8:30am but I'm already well into my day- stretched out, warmed up,  caffeinated, and halfway through a medication pass. But I'm hungry.

"Hey!" The man coming toward me yells. He is in a group of people who are all laughing at a joke. He's leaning towards the woman next to him, and she is looking at him adoringly, but he has inturrupted the moment by addressing me.

He points at me, "I had a great bowel movement! Thank you!"

"Awesome!"

And I mean it.

New Grad Orientation

This morning I was taken off my normal team of patients and scheduled to do orientation with a new grad nurse.

"I had plans," I protested weakly, "I told my patients I'd be here in the morning."

But the beauty of a 24 hour job like nursing is that someone else, just as qualified and caring is always there to make sure things go smoothly. So off the unit, to the back room I went with my new coworker and the Computer On Wheels.

We were only a few minutes into a discussion about a pharmacology quiz question* when I realized that this was one of the best things to happen to me all week.

Teaching forces me to examine my own habits and compare the things I do to best practice standards.
And it challenges me to find new ways to explain old knowledge.

 I love the chance to say all the things that have stuck with me, passed down from my mentors over the past few years. Plus any and all things that  I wish someone had told me sooner.

Still, orientation isn't the whole process. It's obvious to say, but most of the journey from student to professional nurse comes from experience. You have to put your hours in. You have to own your victories, as well as your failures, and make notes and revise your approach accordingly.

I'm no veteran. I am still learning new things every day, and will hopefully never stop.
 But when I get the opportunity to spend so much time with a new grad I can't believe how quickly the last three years just flew by. It feels like yesterday I was running to make it to my NCLEX on time, thinking in the back of my head :
          it's kind of okay if I miss it anyway because I'll probably fail it and I should have taken a prep course and I can't imagine I'll even get half the questions right and what am I doing trying to be a nurse when I already have such a successful job as a drama teacher and I wonder if I can make that work full time?

Now I'm signing off on someone else's skills list.
 And in no time at all, she will be too.

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* Identifying Abbreviations. This section of the Pharm Quiz nearly always sparks a discussion about the obvious disadvantages to using certain abbreviations because they are so ambiguous/easily mistaken for other things.

... only thirty two

Here is a video that was made about BHCHP.
 It has a lot of focus on the building I work, and features a ton of my coworkers and patients.
And the song throughout it, which is an original piece by a patient... well, you'll just have to listen for yourself.


I love my job.

Happy Nurses Day!

Nurse Appreciation Week begins each year on May 6th and ends on May 12th.
Today is internationally celebrated as Nurses Day because it is Florence Nightingale's birthday.

Yesterday at work there was an amazing feast of food for all the nurses. Nurses gathered, not just from our facility but from several BHCHP sites. We chatted as we nibbled on our shrimp kabobs and tried to guess who was who in the black and white nursing school graduation photos.

The spread was prepared by our incredible kitchen staff and was maintained from 12pm to 4pm to bridge both the day and evening shifts. There were tote bags for everyone with snacks and Dunkin Donut giftcards, and in the corner of the atrium two massage stations had been set up.
During the course of the afternoon several touching speeches were given by RNs from the organization, and various staff members were recognized publicly for their work and dedication.

Later on, completely unrelated to the festivities a newly homeless patient said to me, "I'm so glad they brought me here. I know that here you'll take care of me."

It made me feel very appreciated, and made me proud to be a nurse. But there was one more gift, maybe the most affirming of all.

Upstairs in the nurses station there was a vase of roses. Pale pink, with dark edges, and fragrant.

"Did you like the flowers I got for the nurses?"
He was smiling. He had gone to great lengths to get them.
And it was the patient you might have expected least of all.

Dreams of Haiti

I bade a friend goodbye this morning before she boarded a plane to Turks & Caicos. 
She is flying from there to Milot, Haiti.


I am proud.  I am envious. 

Rx: feline

"Sam*, can you at least take your antibiotics?"
"I'm not takin' any of 'em. Why should I? You weren't here."

He's had so many head injuries, that he's now a kid trapped in an adult body. His face is scarred and his body is scarred and his liver is scarred, and his heart hurts. Not his real heart. Sam's lonely.

"Sam, another patient needed me,"  I faltered, weighing  HIPPA against his anger.
"It was an emergency, I didn't know how long I would be in the other room when I went in."

"I don't care. You were supposed to be here. You weren't. I'm gonna go smoke."

He doesn't understand waiting in line, or being told he can't do what he wants to do.  What he wants to do is drink a lot of alcohol and smoke cigarettes and eat cinnamon buns until his glucose level is unreadable on the glucometer. He tells me the higher the number, the better. "Like basket ball scores."

Before they reach a certain stage in both their mental and emotional development children are unable to think abstractly enough to put themselves into another person's shoes, or to plan for the future, or to delay gratification.

Sam is a little like that. Unable to understand why a nurse would not be on time, or why he shouldn't cuss out the doctors, or why he should care about his blood pressure.

Just like a child, retarded emotional development doesn't mean Sam is a bad person. It just means he is where he is. Unlike a child, however, he's not going to progress. His brain is damaged. He may be able to learn behavioral modification - but he's not ever going to reach the next stage. He's stuck.

So whenever Sam is my patient I take my time to remember that and treat him accordingly.

"Hey Sam, you look nice today. I'm sorry I wasn't here for you earlier. Can you take your medications now?"

"No. I'm going to sleep."

Usually it's me who is called in to reason with Sam, some other nurse at her wit's end. Today, I'm the bad guy. Because another patient was vomiting and I was late with Sam's medication cup.

I'm putting out fires. Vomiting, hypotension, dressing changes, patients with frightening hallucinations. Pharmacy's on the phone asking about prescriptions never sent. Due to a "boil water" alert I'm rationing bottled water.  I have three patients with persistent elevated temperatures possibly related to their illnesses but much more likely caused by dehydration. I am watching everything.

As I run around, Sam is in the background of everything I do. Standing in the hall. Sitting in the clinic. Riding the elevator. He takes his meds from me, quietly, an hour after refusing them. He says little all day.

Then, as I'm leaving, he's telling a respite aide:

"I had three cats," he said, "named Mud, Mud Junior and Mud the third."
His eyes glow with excitement as he continues, "and I used to feed those cats better than I fed me. King crab. Shrimp. They loved that stuff. I'd go buy it for them."

It is the first time I see Sam smile all day, talking about his cats and how he took care of them. How he loved them and they loved him.

He notices me listening and waves cheerfully, the morning forgotten.

I leave the building deep in thought,  wondering how one would word a prescription for a cat.

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*names, diagnoses, and situations have been changed to protect the privacy of patients and staff involved

very smooth

 The Charge Nurse was holding a nip of Christian Brothers brandy in his hand when I walked into the nursing station.

"I'll take care of disposing of it," Nurse Nightingale joked, pretending to grab at the bottle, "I know exactly what to do with it."

"So do I," joked Nurse Sassy, but I'm not a brandy person myself."

I grabbed the bottle and waved it dramatically. "Let's pour it on the cookies I baked, then we can- "

"Light them on fire?" suggested Sassy.

"Cookies foster," the Charge joked, taking the bottle back.

"We don't even know if it's actually brandy," Nightingale pointed out.

"It looks more like whiskey," Charge said.

"I bet it's Listerine," ventured Sassy.

"Where was it?" I asked.

"In the bathroom on the toilet:" came the answer followed by an agreement that it couldn't be brandy.

"No one would leave a whole nip of Christian Brothers in a bathroom," Nightingale pointed out.

"So Listerine," Sassy said, and then: "You know what?  I'll do it, I'll smell that."

Charge handed her the bottle and we watched, waiting. She unscrewed the tiny cap and brought her nose down to the tip of the bottle and immediately pulled her head back.



"Yeah. It's piss."

Let's Dance for 100 Beds Tonight

Do you love 90's music? And dancing? And... beds?

Tonight at Middlesex in Central Square Cambridge, MA they'll be pumping up the 90's jams for a cause is not only worthwhile, but specific and measurable.

I found out about 100 Beds for Haiti through connections I made while working at Hospital Sacre Coeur in Milot.  Their goal is simple: to send 100 beds to HSC by June 2010, and guess what?
Thanks to great organizing, 100% of the money raised is earmarked for this specific cause.

These beds will improve patient care now, but will also allow the hospital, which not only services the earthquake victims, but also serves as a health care center for a larger, local community to develop long term plans for sustainability.

So come on out tonight at 9pm and meet me at Middlesex at 315 Mass Ave in Cambridge, MA.
It's a $5 donation at the door, we'll rock out to some Spice Girls and Michael Jackson, and before you know it we'll have made it possible for this amazing hospital to be even more amazing.

I'm not convinced yet. Why beds?
Before the earthquake HSC was just a 73 bed hospital, but in a matter of days it expanded to welcome more than 400 patients. There were at least 175 mattresses that I know of donated by a cruise ship, and probably more than that from near and far as well, but many of the patients we cared for rested day and night on bare cots.

While I was in Milot the hospital was home to about 273 patients; as of March 17th they have discharged some more to Port Au Prince, but the hospital plans to continue offering services to a newly expanded population.

It would be great to start expanding the number of beds to match the number of patients. Having proper beds improves patient outcome by limiting post op discomfort which in turn aids in speeding physical therapy tolerance. PT promotes rehabilitation (obviously) but also prevents complications such as pneumonia and DVTs. Plus.. I didn't assemble a sample group or crunch the numbers myself, but from sheer observation in the tents I can tell you that decubitis ulcers (bed sores) seem to form quicker in patients who are cot-ridden as opposed to bed - ridden.

Imagine surviving an earthquake, a painful and debilitating crush injury to your leg and an amputation  in a very limited surgical environment only to die while in recovery from a preventable condition like a DVT or an infected bed sore?

Adding more beds to Hopital Sacre Coeur serves a short term and a long term purpose. It  improves the outcome of patients who are currently being treated and it also offers sustainability for the hospital's future. Part of CRUDEM's mission is continuing to stabilize HSC so that even when the foreign volunteers begin to dwindle, local staff can continue to offer exceptional care to their patients. Adding 100 more beds allows HSC to plan for the long term development of their recovery center.

Check out the facebook event for YoYoYo 90's Jam: Heal the World Edition, and  invite your friends. Then grab a slap bracelet, a mood ring and a five dollar bill and meet me at 9pm. Simple.

i'm so glad that trouble don't last always

"There's a gospel choir from BC downstairs," I told the patient as I thumbed his dilaudid into a paper cup.

"You mean BU," he said, "Think about it. Gospel from Boston College?"

"Why not?" I asked, puzzled. He took the pills and swallowed them with a grimace.

"Catholic music isn't that happy," he pointed out. "I'd know - I'm Catholic."

I grinned as I headed downstairs, remembering how my mother would often roll her eyes and ask me why the adolescent choir at St. T's never sang anything she could clap her hands to.

Down in the Atrium a modest crowd had gathered to hear the (BU) Choir sing. Another RN waved me over to where she was standing, "They just did that James Taylor song I love."

The choir launched into a spirited number with the rhythmic hook "I love you more than I did the day before." I was suddenly reminded of a day I had spent not too long ago also listening to a gospel choir - a day I never wrote down, so I made a mental note to store as many details as I could when I got home.

We were in the tent. By 'we' I mean myself, the other RN, the two interpreters, the 36 patients, and 20+ family members I had grown accustomed to sharing space with. The air was buzzing, not just with talking but with the noise of music being played over amplifiers.

"You coming with me," said one of the patients I was closest to - a 21 year old with post quake bilateral above the knee amputations*, a wicked grin and a penchant for wheelies.

"Where?" I asked.

"To the program!" he answered and flashed that smile I had begun to count on to punctuate everything he said.

I declined, and away he rolled, all style and flair. I moved on the task of finding a thermometer.

"Hey, come on," said my translator noticing that I was standing still, "you have time and we'll go."

He took me by the arm and we exited the back of the tent. We walked along the barbed wire fence strewn with laundry, passing small children who stopped to openly stare at the blanc  as we went by.

We passed the row of tents and our feet beat on the rocks as the music got louder and louder and I began to make out voices. Up past the small building for less acute Tent City patients  and around a corner there was a small yard. A stage had been set up, and on stage were the same men in suits who had come into my tent to sing that morning. Off to the side there were several other groups of well dressed men warming up.
 It was a Gospel Festival.

Their audience sat in old fashioned wooden desks, the kind with the chair and the wrap-around arm. They had been taken out of the school rooms and set up here. The yard was stubbed with short fat grass, but was mostly rocks and dirt. Friends assisted their wounded loved ones to navigate crutches and wheelchairs over the ground to find preferable vantage points. I spotted Mr. Smiley and his sister, but they didn't notice me.
Like everyone else they were completely wrapped up in praising and singing.

"This is the Gospel Program," the interpreter said next to my ear. I moved out of the way as two men entered the yard flanking a woman with one leg using crutches. They guarded her as she found a place to stand in the shade. A cool breeze blew on our backs, and rustled the green leaves against the sky. The men sang of everlasting love into their microphones. Men and women clapped their hands or nodded along as children played tag, shrieking happily like children do when they are outside and no one is telling them to be quiet.

Not for the first or last time that week, I was amazed at how much joy a community can contain after enduring so much grief.

Back at work watching my patients dance in their seats, I thought it again.

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* "Look!" he exclaimed when we met, "we're the same height!"

Unpacking Haiti, One Week Later

For the first week back, things were weird. And I wrote this and never published it. And now I'm feeling a bit more settled into my normal life, so I thought I'd share.

The shock I've been experiencing isn't traumatic, or upsetting. It doesn't make me freeze up, or have flashbacks or anything like that. I'm eating well and sleeping well, and I'm feeling really great.

In fact, a few coworkers who have not gone to Haiti said "you all come back with the same glow about you."

And we definitely do. I am nothing but happy that I went to Milot and met the people I met and did the work I did.

The shock part is subtle and cultural and environmental. I want to stress how it's not difficult to deal with, only that it's part of me now that layers a new dimension onto otherwise normal situations.

I was only gone for one week. And here only one week really passed. But for me, time in Haiti was all relative. An hour could feel like a day, or an afternoon like ten minutes. I felt like I was in Haiti for much longer than I was because so many things happened in such a short time frame. I went through so many emotions and discoveries in one week that it can't have possibly only been seven days.

Now I find myself thrown back into schedules of rehearsals and dates and plans, and people are referencing things we did together only two weeks ago, and I can't believe when I'm caught up in it all, that only last week all the details of my reality were vastly different.

I was not there long enough to forget how to drive a car, or what pizza tasted like. But I also wasn't there long enough to process all the things I saw and did and felt. So coming back is a strange mix of feeling sometimes like I will never be the same, and then thinking maybe nothing's changed after all. I feel like I was plopped in and out of an alternate reality. Since nothing here is different, it's hard to imagine that I went at all sometimes. And the lines are blurred even more when I'm sleeping.

Every night since returning (and even when I nap)  I dream that when I wake up I will put on my scrubs and spray DEET on my neck and fill my water bottle from the filter and walk to the hospital. Without fail, in my dreams I am writing out to do lists, and I remember which ones need a new IV line today, and which ones have a wound dressing due. In my dreams I am eating a grapefruit with Colleen W. and we are talking about the orphans.

Then I wake up and I'm in my cozy room under my white and purple quilt, and the contrast is startling. But even more startling is the realization that although the dream wasn't real the people and places in the dream are very real. As I sing at karaoke night or read the news on my itouch on the bus they are out there somewhere else in a land of palm trees and poverty. But "somewhere else," might as well be a dreamland because even if I do get to go back to Haiti, most of those particular  people will have moved on by then. I may never see them again anyway.