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.

... 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.

Nurses Gone Wild: Ft. Lauderdale

 Day One (actually).

I should have called the previous entry "Day Zero," since today will be my first day in Haiti.
This will likely be my last blog update, although they said there are computers on the compound.

Had a lovely day yesterday, mostly all to myself, in Ft. Lauderdale since Colleen and Yolanda were delayed at Logan. I even got a slight tan sitting by the pool! (I know:  it's unhealthy. I'm over it.)

After dinner we embarked on a mission to Target because another co worker, Ashley, called to tell us that the hospital ( Hopital Sacre Coeur) needs staplers badly - all the patient charts are falling apart and documents are being lost. Funny how we don't think of it, but office supplies are all part of keeping patient care flowing smoothly.

Our cab driver for the evening, a Jamaican man named Seymour, quickly became our new favorite person as he explained his retirement plan. Then we had a sing-a-long with him.

When Stacey arrived I was already asleep, but it wasn't very late. My anti malaria pill knocked me out. Thank goodness that little monster is just once a week.

We're heading to the airport soon but our flight isn't until 10am. My phone works on the frequencies in Haiti, but it's expensive to do much besides text message. I can text  to Twitter, so that's your best bet for anything particularly interesting or important especially if you're following from BHCHP. Just keep in mind because my phone is not very fancy, I can't see any responses. If there's an emergency at home - please text straight to my phone. I'll get it, and receiving messages over there is included in my bundle.

Endorsements and Plugs Before I Go

I've been promoting BHCHP a lot for all the work they have done to make this trip possible. Now I'd like to take a minute to thank Improv Asylum. As soon as I mentioned going to Haiti I was given time off to leave, and the cast has been super supportive in covering the shows I will be missing (especially Kiley and Jane who have to step up for all the female roles). So ...  thank you everybody!

Also, be sure to check the grand opening of our newly renovated theater in the beginning of March!
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Tuesday, at my favorite laundromat in the world, Don Zar donated a free load of laundry to the Haiti cause, allowing me to get all my scrubs ready for the trip. The Laundry Room Etc., located on Mass Ave near Porter Square is fabulous. It's more expensive than the laundromat near my apartment, but I haul my stuff to Porter just because Don is so great, his place is so clean, and the environment is so cozy. If you have to use a public laundry room, you should go to his. Check out my Yelp review here.
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I won't be able to do it while I'm gone, so please, please remember to vote each day for Boston Healthcare for the Homeless' Dental Clinic to win the Tom's of Maine grant money!! You can vote once a day for up to five different clinics. BHCHP plans to use the money to create a more focused preventative dental program for HIV+ and diabetic patients. Preventing health problems in these patients saves money in the long run. But more importantly, because of the severity of certain complications for diabetics and AIDS patients, it can also save lives.
This means a lot to me, so please go ahead and cast that daily vote!

The Things I'm Carrying

I am leaving Friday morning for my trip and I find myself in full speed ahead mode, which explains the lack of sitting still and blogging, I hope. Almost everything is done, leaving me with some time in the next few days to relax, dine with family and friends, and second guess everything I put in my duffel bag.

I have been busy tying up loose ends (paying bills that will be due while I'm gone, finishing the script proposal I was working on all month, etc), so that I have nothing to worry about once I'm on my way.*

I've also been involved in more direct preparations like buying supplies, and transferring money to a Caribbean plane company since they don't take credit cards.

Since BHCHP first started sending people over to help staff at Hospital Sacre Coeur enough time has passed that nurses have now returned. They pass on stories that are emotional, unbelievable, inspiring, and energizing. 

They've also been passing on really useful advice about things we'll need, and things to expect.

Packing has been a big deal. I like to travel lightly, plus one leg of the trip is in a cargo plane where weight counts! Still, I don't want to find myself unprepared for working the 16-20 hour shifts every day while staying healthy.

Here's a breakdown of what I'm bringing:

-Clothes. The hospital, like many hospitals here, supplies scrubs and there are staff who do laundry for everyone. So most people going down to this particular hospital have to only bring pajamas, underwear and socks. However, because I am so small I'm concerned that they won't have scrubs to fit me. Half the nurses I asked said "it won't be a problem," and half said "you should bring your own scrubs." So to avoid any form of work-disruptive uniform failure, I unfortunately have had to take up some valuable bag space with scrub pants and tee shirts.

- Medical Equipment. I'm bringing my own scissors, tape, and stethoscope and a fanny pack for carrying patient meds in the tents, as recommended. Each team member is also helping to bring donated supplies from BHCHP** such as gauze, sanitizer, bandages and gloves by taking as much as I can fit in our checked luggage. 

- Nourishment. The food situation is apparently good. Staff gets three meals a day, but although the food was raved about by the nurses, they also said it wasn't enough (quantity wise) to sustain them for those long shifts. My eating habits are defined by "grazing," and  I'm a person who becomes disoriented, cranky and labile when I don't get to munch. So into the bag went a ton of energy bars from my local Eastern Mountain Sports.

 In the same theme, there is apparently plenty of good, clean, bottled water where I am heading. However, it's easy in temperatures that are consistently over 100 F, to overdo it on "free" water. One of the MDs there a few weeks ago actually became severely hyponatremic ( his Na+ was 113!). He had a seizure and experienced some rhabdomyolysis to boot. To prevent this, I invested in some nuun tablets.

- Physical Needs. Normal toiletries plus a super absorbent towel, a personal first aid kit, all the medications listed in my Travel Clinic post, SPF 40 sunblock, and DEET. 

-Emotional Needs. My prayer book. My journal. My ipod. And, of course, my awesome team.

On the subject of "my awesome team,"  I am so excited about the people I am traveling with. To be fair, I thought about it and realized there is no one from work who I would not be excited to go with. Still, Colleen W. is in my group and she and I are close friends besides being good at working together. 

This past week, at an old friend's birthday party I got to talk briefly with an acquaintance who spends a majority of his time in Haiti. In fact, he was already there serving as a member of the medical community with Partners In Health when the earthquake hit. I told him that I felt like what I'm doing is small beans in comparison. 

But his response was reassuring, as he reminded me that they need nurses, and that's why we're going.

Our work is only a small part of a much larger picture. But I am grateful for a chance to work on something so big. 

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* Go ahead, you can say it. I'm the model of functionality. I know. 

** The fact that a non profit is donating medical supplies to this cause takes my breath away

Tom's of Maine Contest

The Tom's of Maine community voting project continues. You can vote for up to five clinics once a day until March 12th. Please go to the Tom's of Maine website and vote for Boston Healthcare for the Homeless.
We would like to put the $20,000 towards a new initiative to target the dental health of diabetic and HIV/AIDS patients.

BHCHP in Haiti

Boston Healthcare for the Homeless was approached recently  for help with relief efforts at Hospital Sacre Coeur in Milot, Haiti. In response, BHCHP has committed to sending four staff members every week for six weeks, for a minimum of one week of service for each group.  

The first group is already there, including two McInnis House nurses. We've been in touch with them, they are working in the Emergency Room and the Psych Unit respectively. 

 The next group leaves this Friday. 

From staff members who are unable to make the trip at this time, the response is just as overwhelming. People have been donating hours to the "vacation bank" so that those who are going don't use up vacation time, as well as donating items for the staff like hand sanitizer and insect repellent. And, at McInnis House at least, since I can't speak to other parts of the program, nurses have been stepping up to cover shifts while the others are away.

There is amazing team work happening here at home as well as in Milot. 

I am always proud of the work that we do, but seeing everyone around me jump at the chance to contribute to Haiti's relief efforts gives me yet another reason to love this program.

..if you just smile

Tom's of Maine is one of my favorite companies because I have loved their products for years and I love their commitment to community. As many of you may already know from talking to me or browsing through Facebook, right now Tom's is getting ready to grant five different clinics a $20,000 sponsorship. And they have decided to let communities vote to determine the recipients.

You can go onto their website every day from now until March 12th and vote for up to five different clinics.

Annnd... (here's where I come in) the dental clinic of Boston Healthcare for the Homeless is one of the clinics in the running. Specifically, they are being considered for their initiative to create more support for HIV/AIDS and Diabetic patients.

BHCHP has been targeting the oral health of homeless men, women and children since 1985.

As of right now they have two locations (Pine Street and Jean Yawkey Place) where our patient population can easily access comprehensive dental services from cleanings to denture fittings.

If our dental clinic is awarded the sponsorship they'll be able to hire a new dental assistant who will be specifically working to provide fluoride treatments and oral hygiene education to patients with HIV, AIDS, and diabetes who are at risk for serious health complications otherwise.

This paradigm shift towards primary preventative healthcare would be huge in stopping very avoidable oral health issues from snowballing into major medical problems.

Please. Please. Please. Take the time to go vote for BHCHP. And maybe a couple other clinics whose ideas you like, too. And remember you can vote every day, for up to five different places.

This kind of financial support in the hands of the dedicated programs listed on the Tom's website can only lead to good things happening for quality, accessible care.

Flu Prevention Video

Last spring I was approached by some folks at Boston Healthcare for the Homeless for some creative assistance. They wanted to make an educational video clip, short enough to be looped, to use in clinic waiting rooms. So this is the video we came up with.
The clip features the music of Stroamata, and the acting talents of some of BHCHP staff and clients.

Healthcare on the Brain

On 8/31 cuts were made to Commonwealth Care causing 31,000 legal immigrants to lose health care coverage.
On October 1st they will be enrolled in CeltiCare, but in the meantime they are being covered by Health Safety Net.

The problem is that there is a myriad of services not covered by Health Safety Net including outpatient non-urgent services. Which means chemotherapy, dialysis, and other important therapies can not be paid for. In many cases, this will mean termination of therapies until Oct. 1.

Fortunately for the percentage of my patients that these changes effect, they have someone to go to bat for them. Administrators at BHCHP are willing to work with the Office of Medicaid and Commonwealth Care to try to cover treatments on a case by case basis until the transition period is over.

Hopefully they will be successful. It's one more reason why I love where I work, the fact that people are consistently ready to go above and beyond to advocate for every person's right to health care.

I worry about the people who don't have anyone to advocate for them. The young, or elderly or non English speaking or mentally impaired legal immigrants who are not part of our system. I hope their doctors are also speaking up for them. Everyone has a right to the care that they need.

And without getting any more political, that's all I have to say about that.

I am a Respite Nurse

"She works at a homeless hospital..."
"You work in a nursing home, right?"
"How did you get involved at the shelter?"

A lot of people are a bit unsure of what I do. And I don't blame them. I had never heard of "respite" nursing before I applied for my current job. And I went to four years of nursing school.
Even the EMTs who respond to our 911 calls (wait - don't you work in a hospital, why are you calling 911?) are unsure of where they are. ("What kind of shelter is this?").

This video is new, I have never posted it before. But it explains what respite nursing is, and more specifically shows you exactly where I work (and who I work with!) every day.

Although I had never heard of respite care before, after two years, I am a very strong supporter of it. I would like to see more programs like this one form all over the country. I think that educating the public on what we do is an important first step in gaining future support for respite programs.

http://www.nhchc.org/Respite/

Nurse Appreciation Day (or: a nurse on nurses)

Today Boston Healthcare for the Homeless celebrated Nursing Appreciation Week. We had an amazing lunch prepared by our constantly devoted kitchen staff. The lunch was followed by speakers. Unfortunately, I had to return to the floor to work, but I did get to hear a small part of one of the presentations when I came back down to summon a co worker to the unit.
Here's what I picked up:
Up on the projection screen was a picture of St. Francis of Assisi. The presenter, a nurse from one of the other BHCHP sites was speaking passionately and resolutely of the similarities between Francis and nurses.
As I looked around the crowd, trying to find Ashley so she could sign off narcotics with me I saw nurses of all ages and at all points in their careers nodding. Smiling.

"Nursing isn't an office job," the speaker was saying. "Sometimes it has to be. When you get into administration. But when you get down to it, nursing isn't about sitting at a desk. None of us were called to that. We couldn't chose anything other than nursing."

It was a brief segment of a larger talk and it inspired me while I stayed in the room of nurses, but as I returned to the floor alone I felt it began to resonate in a very different way. And I realized:

I rarely hear nurses talking about how they really feel about nursing.

It doesn't end at a simple lack of discussion, the absence of which could be attributed to an unstated understanding of a shared purpose. Surely astronauts in a shuttle don't review their mission statement every morning? But with nurses it goes beyond a lack of discussion. Sometimes it can become a complete denial of how special and important the field is.

Occasionally someone might ask, "why did you go into nursing?" and even then any zeal, emotion or passion (which was almost certainly involved in the decision) is often brushed over for a mild answer like "I always wanted to," or "Oh, it runs in the family."

Before anyone gets defensive, I'll admit exceptions. Especially when the group of people talking are particularly comfortable with one another.* Still I have found that nurses tend to downplay what they do, no matter what.

As a new nurse this aspect of the culture is learned through example, and passed on quickly.
In time a very casual, matter of fact - or worse, bitter, attitude about Nursing can replace the initial excitement and passion of a new nurse graduate. If we ran around all day talking about our calling and our love of healing people would think we were braggarts, or worse - crazy. That kind of language, the language we learned to speak when writing "Why I Want to be Nurse" essays becomes taboo. Instead, we try to talk about our shifts as if we're working a cubicle job. It's less grandiose. Less insane. Less dangerous.

The nursing sector of the blogosphere is substantially populated with LPNs and RNs offering pithy recaps of incompetent co workers or impossible patients. There's a lot to complain about when you spend enough of your days taking care of other people's problems. There's a lot to break your back, and even more to break your heart. But it's more interesting and less dangerous to be funny than to be ... anything else, and some blogger RNs excel at medical snark so readily that they can hardly be faulted for failing to embody the Nightingale Pledge "to abstain from whatever is deleterious and mischievous."

Unfortunately, this too is a form of downplaying what we do every day. It's a great coping mechanism to be sure, but it short changes the experience just a tad to never acknowledge that the job is more than a collection of witty anecdotes.

So how else to talk about nursing?
When I write entries about nursing in this blog I can tell you that I second guess myself with each sentence. I feel like I'm sounding too saccharine, too "Chicken Soup," and at times a bit too moral - driven. That's the "at best," scenario. At worst, I worry that I sound too self-serving, too proud, and too full of myself.

I've concluded that must be why most nurses don't talk about what we do with any degree of pride or realism. To actually discuss what happens on a day to day basis would surely be to implicate ourselves as more important than we are generally comfortable with people thinking we are. A good nurse is often a good nurse in part because he or she refuses to believe there isn't still room for improvement at the end of every day.

In nursing school our talk is the talk of vocation. We all talked about wanting to make a difference, wanting help people. We promised to always advocate for the patient. We promised to question convention, to look to evidence based practice to further standards of care. We wrote heart felt, tear jerking essays about why we didn't just want to get pinned but we needed to get pinned to fulfill our sense of purpose. A purpose still as young as our hearts were at the end of college, but a purpose that seemed pure and virtuous.

But that kind of talk fades out. And I am not entirely convinced it's because we suddenly wake up and realize that health care is a mess of HMOs and paperwork and burned out systems, although those things are certainly true. I'm more and more inclined to believe that we stop using the language of zeal and vocation because of modesty and embarrassment. Humility, which is so endearing in a great nurse, is also exactly what stands in the way of direct communication about what it is we do every single day at work.

Thankfully, because I work for Boston Healthcare for the Homeless that kind of talk isn't only resurrected during Nurses Week. At every chance they get, our administration reminds all of us, nurses, respite aides, kitchen, security, M.Ds, P.As, N.Ps, housekeeping and maintenance, coop students, and departments like finances, development, and H.R that what we're doing is good, and worth it, and that we're all in it together.

Still, the next time I hear two nurses talking about the job I would love to hear them tell one another, "Hey. It was a rough day, but you're still making a difference." And have the other answer, "Thanks. So are you."**

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* One of the millions of reasons I love Boston Healthcare for the Homeless is that it seems every nurse I know has a very passionate story about why he or she is a nurse. Or about why he or she chose BHCHP. And we all share our stories freely. Really, I work in a strange and wonderful place.

** P.S: Entries like this are going to ruin my comedy career.

Boundaries Committee Heads North

Early yesterday morning I left Boston with Caroline and Colleen for a work related retreat at our DON's house in Vermont. As I slid into the back of Colleen's car Caroline passed me a mug, a bottle of milk and a pot of coffee. I smiled and helped myself, "Now that's friendship."

We worked most of the day on our goal: to write the script for the Medical Professional Boundaries video we're creating for BHCHP. Later this spring I'll assemble a film crew and direct the actual  production. It was my first time running a writing workshop of this kind and I incorporated some improv games to get creativity flowing. It went better than I could have imagined and we finished the script and more. In between writing sessions Debbie's mom fawned over us and fed us delicious meals, and we bonded over shared nursing experiences. When nighttime came we stayed up late all together in the living room, not having run out of things to say. 

It was a much needed respite from every day life in addition to being a very productive work session. 

I got called in to sub for the 8p and 10p shows tonight so we skipped antique shopping on the way home. Time passed quickly as I was more and more impressed by Colleen's ipod. Our musical tastes are similarly eclectic and we sang everything from Les Mis to Paul Simon to Outkast for at least two hours out of the three. It's great when you can actually be friends with the people you spend most of your time with. 

There's so much encouragement at BHCHP for staff to take initiative for seeking  better practice all the time. This project is a grassroots movement, nursing driven, which will hopefully help staff in all areas of the program. Bonding with others over our common goal is what makes this job so spectacular. And it's what keeps us doing what we're doing.

A very reaffirming experience all around.

One Step Forward, Two Steps back for low income Mental Health

A short time ago I wrote about MGH's decision to put a substantial amount of funding towards a collaboration between the Department of Mental Health and Boston Healthcare for the Homeless.

This article today in the Globe brought some disheartening news: because of the state's budget cuts the Goldfarb is shutting down. Surely some of the clients from the Goldfarb will be able to get mental health services from BHCHP, but not all of them. This is terrible news for those clients, but also for society in general. Crime rates WILL go up, and public morale will continue to fail.

Hope Realized

Today this article from White Coat Notes showed up in my Google alerts. MGH is going to provide a TON of funding for the Department of Mental Health to work more closely with BHCHP.

This is great great news for BHCHP.

Because I believe firmly in holistic approaches to healing, I don't think that health care for anyone is truly complete without a mental health component. Even in the absence of a DSM-IV diagnosis, every one of us has the potential to have spiritual, mental, and emotional disturbances in response to a physical ailment. When these are ignored, well being suffers.

It is especially important in the homeless population to have mental health care due to the fact that mental illness can cause and/or perpetuate homelessness. The prevalence is outstanding, and without proper programming the most we can do in many cases comes down to short term fixes or harm reduction.

Bob Taube is quoted in the above blurb as saying that this move by MGH is going to "revolutionize the way we practice medicine," and I couldn't agree more.

Hit the Ground Running, Don't look back.

Today marks the beginning of a thirteen day stretch of work. Needless to say, I am pouring myself another tall glass of water and chewing on a Mojo bar as we speak.
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Today at work everyone watched the Inauguration. Some patients watched it in their beds. Some gathered in common areas. Some of the nurses or practitioners were able to get smooth enough video streaming on cnn.com or nbc.com. Most of us however, went to the 2nd floor. The spectacles of the day were showing on the flat screen tv in the patient activity room as well as on a huge projector set up in the Atrium. Staff and patients gathered in both rooms to watch the events unfold.
I had the same meta- feelings I had when I was in Tokyo watching the election coverage. "This is what I'll remember," I kept thinking. I will remember a family of people, all of us together there together in our "living room." We are, just as Obama said of America itself, not related by race or religion or blood. Instead, we are related by a common cause. An ideal. A dream. We are related by the idea that everyone matters, everyone deserves a second chance, and most importantly, everyone deserves access to good health care. And we gathered today to hear from a man who promises that we can continue to pursue this dream of ours. I believe in the new administration, but more importantly I think, I look around every single day and see the people I work with and I believe in them. And they believe in me. And we do it every single day.

Three Things

1. Boston Healthcare for the Homeless was featured yesterday on The Daily Grommet. The video interview with Cheryl Kane, RN will be featured for four more hours as their front page but is still available to view in the archives after that.

2. Three Hole Punch would like to issue a very warm welcome to our new director, Scott Braidman. Scott has been working with the ladies of 3HP for years now in various capacities, beginning with a five year presence in Mission:IMPROVable at UMass Amherst as a performer and producer. He graduated UMass with a degree in theater, and now performs regularly at Improv Boston in the Family Show. He has performed with Improv Asylum's NXT cast, recently directed What Does America Mean to Me by Boston's own Marc Hirsch at Improv Boston in 2008, and is currently featured in Improv Boston's 8th Annual Holiday Show.
Scott is joining us just in time for 3HP's upcoming debut of our first full length show: Flirty Laundry, which will run Wednesday nights during the Hump Night at Improv Boston. And we're all very excited about it.

3. I lied. There were only two things.

..and I spend every day reconfiguring my senses...

EDIT: This post got a little carried away, but recently I have had people ask me how I am able to do so much and not get worn out, and I think this answers it.

Because of the weather forecast for Boston tonight, which involves six to twelve inches of snow depending on who you ask, I have been asked to come in to work a bit early to ensure enough help during the storm. I don't mind that at all, and I have a planned shift tonight of about 2pm to 11:30pm although I know logically that it's the third shift who will have the absolute hardest time getting there and so I may end up working into the night. But here's why I'm okay with that:

Last year, during my first terrible snow storm as a BHCHP employee I stayed on when my relief was late. I didn't mind because I didn't think I could safely get home anyway at that point. My car was completely snowed into the back of our parking lot (we were still located in Jamaica Plain back then) and I would have had to walk about half an hour to my apartment in snow drifts as high as my hips. The woman relieving me had been at work at her other job, at one of the hospitals downtown, where she had just put in an eight hour shift on a med surg flor. She still managed to get to us even with the T halfway shut down. She came in the door rosy faced and covered in snow and ready to keep working. It was pure inspiration, and it gave me the energy to stay for the whole next shift in place of another call-out.

It was one of the first of many moments I would realize how much of a team we are and how blessed I am to work in a place where people really feel committed to each other, to the patients, and to the work we're all there to do. I don't think you can beat that kind of atmosphere in a working environment.

However, I took that energy burst I had from working that shift and I put in way too many extra hours in the next two weeks. I thought I was superwoman. And I ended up crashing hard.

It's easy to get burned out in many public service roles. It happens all the time. It happened to me in 2004 while I was working in Agawam as a CNA. I'm not talking about being tired and overwhelmed and needing vacation. (Which is exactly when you should take a vacation!!!) This was a permanent burn out which required a change of jobs. It's a terrible feeling and it's hard to rise above, even when it's not as permanent as the situation I found myself in.

Since then, I have found that the only way to stay on top of the joy and rewards of work like this is what I like to call a constant reconfiguration of one's senses. Broken down, it means to know yourself really well. It's important to know your own limits and to be honest about them. They may not be the same as someone else's limits. It doesn't do a nurse any good to try to be someone he or she is not. It's necessary to understand your boundaries. And to take time every day to really center and listen to your own needs. And to allow yourself to be gentle with yourself.

Being self-gentle is not related in any way to hedonism, which I despise; it's not my intention to promote that anyone only seek what is pleasurable and easy. I tend to weigh in more on the belief that self sacrifice is necessary for the greater good. I believe that only by sacrificing parts of yourself can you know yourself. But you need to know yourself before you start to sacrifice yourself. I have been in several relationships that have failed due to sacrifices being made all wily nilly without any knowledge of what was at stake.

The beautiful thing about a constant reconfiguration is that you always have room to change and grow. We know we have to push all our limits, because only then can we grow. But you need to take an inventory as you do it. You need to do it with utmost self awareness. It's the difference between changing your mind and being considered inconsistent. Anyone who reads Overcoming Bias knows you can change your thinking patterns, but you have to be familiar with them first and foremost.

Through honesty I own my life more than ever before, even though I still give so much of my life away. People laugh when I say "I do what I want," because I am often talking about leaving the house wearing two different socks. But it 's an easy attitude to maintain throughout every area of my life when I'm honest with myself. Even when I realize I've stretched myself a little too hard, it's alright as long as I admit that and reclaim myself afterwards. I am not overwhelmed by the idea of staying at work tonight because I have mentally prepared for it and it is what I want to be doing.

And it's a lot easier to stay like this when I am working in an environment full of people doing the same thing, which is what makes BMH so great right now. Everyone here is willing to go an extra mile for each other and for the job because we're passionate about what we do and we take care of ourselves enough to stay that way. It's easy to continue to give when the entire team is doing the same thing, and when we're letting each other take turns.

And on that note, I think I'm ready to head into work.

Letter from Tokyo

John Herman, artist, writer and teacher as well as producer of Stranger Than Fiction, wrote an article for The Wire about our trip with Improv Boston to Tokyo and it came out this week. It's called 'letter from Tokyo,' and I am quoted in it, so you should check it out!

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It's been a year since I took this job at BHCHP and my extended family continued to either not understand what I do, or not really like it much. But yesterday as I munched on leftovers with my mother she reported that some of them had read this Globe article a few weeks ago and they are all very happy and excited about it. Which made me very happy.

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A co worker and I are in a heated ongoing discussion about whether or not Americans work too hard. She was born in France. What do you think? As always, comment, message or email