Laundry day. I hate doing laundry. I hate folding and sorting. I hate emptying out the pockets I should have emptied as soon as I took the clothes off. You would think I was doing laundry for a caravan as much as I complain. It is literally two loads, and since I am at a hotel I can do them simultaneously. It still drives me bananas. I guess it could be worse. I could be somewhere without laundry facilities. 

Got my new Bose speaker, and my heart is happy. Amazon sent me some some cheez-its. PPE was delivered to my hotel from some amazing friends. This is better than a birthday! The front desk guy is concerned about my shopping habits. 

Two nights down and two to go before I get a 24 hour reprieve. Night shifts are an entirely different day than working during the day. If it was not so hard on me physically I would prefer them. Making friends with the ER is proving to be smart (it helps that they are awesome) and I was shown the break room and dinner last night. The pasta salad was fantastic! Remember it is always best to get to know the people you are working with. These are the people you can count on when you are far from home.

Sometimes I find myself being standoffish and sticking to myself. It is usually when I am nervous and afraid people will think I am weird, which I am, but I don’t want them to know that yet! I think I am better off just getting over myself and trying to be friendly. Who knows? They may even like me. 

Now for the biggest problem. I have no idea what anyone’s name is!!!! I would never recognize them and it makes me feel so rude. The masks and hats and face shields… ugh. I wonder if they suspect they all have nicknames. There is the badass ER NP. The ballsy manager. The girl I am pretty sure is a charge nurse. The nicest lab tech I have ever met. The cute little shy nurse. The nice bald dude that acts like we have met, but I am not sure where and it is too late to ask now. 

I probably will not be here long enough to get all these people sorted out in my head, but I hope they know how much I appreciate them. I got here after the whole disaster was already getting better. I cannot even imagine what they have been through. I only hope I am helping ease some of their burden. 

Healthcare workers are a special breed of people. We like to believe we have it all under control and we do not like chaos. When hospitals are overrun with patients we have no choice but to figure it out and find ways to take care of our patients. We do not get to close, and we do not get to run away. It would have been easier for me to stay home and wait for a safer, more pleasant job to come along. I would rather be at home with my family. 

However, I am grateful to have the ability to offer something to this community. I am learning so much.

Plus I get to hear cute accents all day. Have you ever heard these people say coffee? 

Day 9

Seems like the hospital I am in is slowly going back to normal. I wish I were slowly going back to normal. I am not usually this homesick when I am working. I guess I got spoiled for the past few months with so little to do. I will be fine, this is a normal part of traveling for work. This also happens when I am working without concrete plans for the future. Right now I only know what I am doing until June 1. So, I feel a bit untethered. It will be okay soon. 

One of the perks of this job is I rarely have time to get bored anywhere. I am always being challenged by something new. So, I feel funny when I complain about having to learn new things all the time. 

The past couple of days have been spent sleeping and working. Today I am back to days for one shift, then back to nights for several. Day shift has one set of problems and night shift has a completely different set of problems. Physically I like days better. I sleep better and feel better. I like the routine of night shift more. Night shift people tend to have sensibilities more like my own. Night shift is also harder overall. I have more anxiety about the patients. I worry more about whether or not I am doing the right thing. I wonder if other people experience it that way. 

I would not say I have learned much more about COVID, except I am starting to see signs of the chronic problems it is going to cause. The recovery is going to be long for the patients I have seen with the virus. I guess that is true for many illnesses. I am still worried what will happen if we have a big surge of patients at home. So far we have been lucky. 

I think my experience at this hospital will give me better experience for dealing with this at the places I usually work in. Critical care is very different from hospitalist work. There is more focus on the things that will kill you today, while once you are on the floor, I am trying to get patients prepared for discharge. It is hard to tell when a patient is ready for the next step in their recovery. It is especially hard if they have other chronic health problems like intellectual disabilities or dementia. Throw in some psychiatric disorders and it is a perfect storm of issues preventing recovery. So, I try to address each issue to the best of my ability and hope we find a solution for each road block standing in the way of success. Sometimes I have to change my definition of success. All we can do is keep trying. 

So, today I will go into work and look for ways to help. I will keep an open mind, and I will offer support to whoever needs it. I cannot save the world, and thankfully that isn’t my job anyway. I will be flexible and see what the day offers. I may even surprise myself and find some ways to have some fun. Maybe that is the point. To make it as good as you can. Let’s see what today brings- shall we?

Day 7

Had a good dinner last night, and would like to say I slept like a baby. I did sleep until the alarm, so there is a small bonus.

Mom sent me some scrub caps and I forgot how much I love having my head covered. I am definitely a hat, scarf, do-rag kind of girl. I don’t know why. It could be laziness. I hate doing my hair.

This morning I am listening to Amanda Shires and wishing I had my little Bose speaker with me. TV is depressing these days. I don’t want to watch the news and I don’t want to see life back to normal on reruns either. I just want to hear some soothing melodies. Oh! And for some reason I fell down a rabbit hole yesterday and started watching interviews and videos of and about Townes Van Zandt. He fascinates me.

People want updates. Not much to say. I do not know how this hospital runs during normal times, but now it is chaotic. I have not found a routine, but I am working on it. I think I will figure it out. Today my goal is to find a list of the floors and their names and phone numbers. Keep your goals specific, measurable, and attainable, isn’t that the advice?

I cannot lie. I am the last to know most things at these hospitals. If information is disseminated on a need to know basis, I guess I am one of the ones who does not need to know. One facility sent me the most “current” information on COVID, and it was literally a copy and paste a viral FB post. 

If you want further proof of the level of my cluelessness, let me tell you about yesterday. I was sitting up in an office working on my notes and desperately trying to figure out this new EMR. I am sitting there, my eyes are squinty because I have a headache, and I am steadily muttering to myself about how stupid all of this is and why can’t things just be easier, when I start hearing the loudest sirens. I thought maybe it was ambulance or something coming into the ER. You can’t get mad about that. Except it just kept going. FOREVER. After several minutes I exclaimed “What the hell is going on???” The doctor working in the office turned and told me to look out the window. There were like a million cars and firetrucks and police officers all driving by. It was like the loudest parade I have ever seen. I have to tell you that was the second time I got all misty eyed and emotional yesterday. 

Every time we discharge a COVID patient they play Rachel Platten’s Fight Song overhead. It is similar to the song they play at some hospitals when a baby is born. I think we are getting fewer COVID hospitalizations, but there still seem to be a lot. 

I wonder what hospitals are going to look like once the surge is over. Are our rural hospitals going to get patients again? Am I going to be able to find work? Are we going to have to keep COVID floors from now on? Or will this just die out? 

We don’t know. I suppose we just have to watch and see. 

For now, I want to say thank you to my friends and family who are sending me supplies, masks, caps, and good wishes. You guys are the reason I can do the job I do. Even when we are not in the middle of a crisis I need the support from the ones I love. I am lucky to have the freedom to be able to travel around and try to help where I am needed most. I am lucky to have a supportive family who take care of my day to day life. I would not trade my people for anything. I am so grateful and appreciative. 

Positive Reinforcement 

My work life has not always been wonderful. I have struggled to learn how to deal with coworkers, patients, and teachers fairly frequently. Maybe I should have read that damn book my Grandaddy gave me when I was 8. Carnegie reportedly had all the answers for how to get along better. I’ve read it since and it basically boils down to being nice and considerate of others. 

I have a rather polarizing personality. You either like me a lot or you can’t stand to be around me. I don’t inspire much apathy. It has taken me years to mellow out and stop carrying a chip around on my shoulder. I also had a horrible inferiority complex. I knew I was different than other people and I assumed that was a bad thing. I never felt competent, nevermind successful. I just knew I was not good enough. 

So, I worked hard and tried to prove myself. Well, actually I turned into an insufferable asshole. People thought I was judging them, but the person I actually despised was myself. So, I overcompensated. I was a jerk. A completely unhappy jerk. 

It made work difficult. I own it. I made lots of mistakes. I just wanted to be better. I wanted to be worthy. 

I was shocked when my dream job didn’t solve the problem. All the people I had pissed off throughout my career were not impressed. All they saw was an asshole who apparently thought she was special. Little did they know I was wracked with self-doubt and insecurity. 

I loved my job though. I wanted to be good at it. I wanted to make the people who had invested time and energy into teaching me proud. I just wanted to deserve their respect. Unfortunately, I had left a trail of people behind me who remembered the wreckage of my feeble attempts to prove my worth. So, they were watching and expecting me to fail. They viewed every single thing I did through a lens clouded with disdain. There was no way for me to earn their respect. Who the hell did I think I was? So,  my insecurity grew. It became a cycle. I cried a lot. I think the most confusing part for me was the incongruity between my sincere love for my job and my misery. 

I suffered from mood swings and my attitude was completely unpredictable. I was either sullen and snarky or overly sweet and disingenuous. I reeked of insincerity. I was moderately paranoid that everyone was out to get me. To be honest, some were. Not all though. I was losing my mind. I could not understand why getting exactly what I wanted had not made me happy. 

I don’t mean to make it sound like it was all bad. It wasn’t. I had some people take me under their wing and coach me until I was actually pretty good at my job. There were many times I was included and made to feel like I was a valuable member of the team. I had people give me their time and expertise freely. They didn’t have to do so much for me. The physicians, pharmacists, and other healthcare providers who invested their energy in developing my skills are the reason I can do this job now. I am so grateful. I hope they know how much I appreciate them.

Fast forward past a very dark time when it became apparent I was not going to be able to overcome all the challenges associated with the job I loved so desperately. I started working as a Locum. I love a lot about this lifestyle. I get to decide when and where I work. I get to move on when I am bored. I have met people all over the country. 

I think I have gotten better at my job. I am able to walk into new situations with confidence. I am not competing with the imaginary person I think I should be anymore. This is important. This confidence has allowed me to stop trying to prove myself constantly. It’s a relief. I allow myself to talk to my patients like they are people instead of patients. I am so much happier. I am a better provider because of it. 

I wouldn’t trade my past for anything. That experience was wonderful and painful at the same time. Now there are times I miss my old job. I miss the familiarity of being with people who have known me for all these years. Sometimes I feel untethered and unattached. So, I keep in touch. My former coworkers have not left my life, they just have a different role. They are my friends. A couple are my best friends. They have seen me at my best and my worst. They are on my side. 

It feels weird to receive compliments, especially written ones. This patient and her family were a joy to work with. It was an honor. This little note gave me some positive reinforcement to keep doing my best. Not because I have a past to atone for, but because my patients, coworkers, and I deserve my best. 

Terminal Waiting

Your wife sits on the plastic sofa, struggling to hide the misery marching across her face. The nurse sits beside her prepared to attempt to soften the blow of our discussion. You are tucked into the recliner with your heavy, waterlogged legs elevated to help reduce the swelling. Your face is painted with the pallor reserved for the poor souls who have survived septic shock. The air is tainted with a musty, decaying, chemical pollution reserved for Intensive Care Units. 

The appropriate demeanor escapes me  as I struggle to find the correct tone for the questions I have to answer on this obscenely neon form. The bright orange paper would be better utilized on a hunting lease. My fingers are cramping under the strain of my attempts to hold my trembling at bay. The gravity of this conversation intimidates me. I am horribly under- qualified for this. 
I scoot the bedside table out from between us and take a seat on the freshly made hospital bed. I attempt something like a smile. Would it be terribly inappropriate for me to crack a joke? Do I minimize the seriousness of this talk? 

Slow, deep breath. 

I intentionally avoid eye contact with your sweet spouse. This is your decision. One of the few things you still have complete control over. I owe it to you to not mess this up. 

“So, I have a form that I have to discuss with you before I can send you home. I know you have already had this discussion, but I have to clarify the specifics and record it so we have a record of your wishes.” 

I glance down at the first item, Cardiopulmonary Resuscitation. CPR. A horrifying act which can sometimes saves a life. I have to ask you whether you want someone to attempt to intervene if your heart stops beating. 

Usually, I make a point to say that I ask everyone this question and reassure my patient I am not anticipating this issue. 

Today, I am sending you home to stop treating your terminal disease. I am tasked with clarifying your directives to healthcare providers. 

“Joe, the first thing on this form is if you want someone to attempt to restart your heart if it stops.” 

You shake your head no. 


Strange how such a permanent decision is indicated with a check mark. It feels like there should be at least a paragraph written there. Perhaps a reassurance to everyone they are doing the right thing. How can doing nothing be the right thing? 

The next item addressed several different options if you develop respiratory failure. I have to ask about each one. 

“If you stop breathing or if your breathing is ineffective do you want to have a tube placed so we can put you on a ventilator?” 

Vigorous head shake. 

“Even if it could be a temporary or reversible problem?” 

Slight hesitation. You mutter something that resembles a no. 

“Would you want noninvasive mechanical ventilation, which is a mask that provides pressure and can sometimes help?” 

I get a blank stare. 

“Ummm. Joe if you begin to have trouble breathing do you want to be brought to the hospital for us to attempt to keep you alive with machines? Even if they would not require intubation?” 

I wait while you appear to consider these options. Finally you glance at your wife and whisper “no.” 

I go through the rest of the details spelled out on the form. Coming to the hospital if your condition becomes worse. Artificial nutrition if you is unable to eat. Intravenous hydration if you cannot not drink. 

I have stutter and stammer my way through each question. I fight the urge to try to convince you to keep fighting. I want to encourage you to “beat the cancer!” This is just a battle, I know you can win the war. 

I look over at your wife and realize she is crying. I desperately need to fix this. I need to give her hope. I look down at the form you have painstakingly signed and initialed and read the most annoying words possible. 

Black Ink Only. 

I glare down at my blue pen. The blue and orange remind me of the colors the football team wore when I was in high school. 

I also realize my cell phone number is written in the forbidden blue ink instead of the office number as my contact number. 

I don’t want to admit my ineptitude. I want you and your wife to trust I have done everything the way I should. I don’t want to give you a reason to doubt your decision. I pull my pager out of my pocket as if is vibrating an alert. I rush back to the nurse’s station and ask for the form. 

“We already gave it to you.” 

Now I have to admit my inability to follow directions to someone else. I start choking and coughing as acid comes from my churning stomach burning the back of my throat. 

It turns out they have run out of the orange paper. She can’t print me a new copy. EMS is here waiting to transport you home and I have not even written your prescriptions. 

Finally someone finds me a new form on a different floor. I stand at the counter and carefully fill out everything but your signature. 

I walk back into the room and lie. I tell you I was unaware there had to be two copies. 

Everyone knows this is not true. You graciously let my obvious gaffe slide. I ask you if you need anything else. 

“Yes. I do. I need a hug.” 

I can barely compose myself. A few tears manage to escape. The lump in my throat prevents me from speaking. So, I lean down and give you a hug. 

“Thank you for taking care of me. Now, is it okay if I take my pills with a shot of Knob Creek?” 

All four of us bust out laughing. 

“Well, you are dying. You can do whatever you want.” 

I brace myself for the stony silence I generally earn when I say something exceptionally blunt. Instead, all three of you laugh even harder. 

I have to excuse myself to write the prescriptions you need to fill before you get home. I know I will never see you again, so I take the chance to hug you and your wife one more time. 

I’m not gonna lie, more than a few tears were shed on the drive home that night. 

Third Time’s a Charm???

Sunset arriving in Tulsa. It is beautiful. Until I walk through the sweltering, damp heat to the rental car.  I am sure I am destined to drown in the humidity. Get to the window and wouldn’t you know it? There is a line. I stand there and sweat. Ask politely for a car with Bluetooth. Get a rocking minivan. 

This morning I wake up exceptionally early. I do not have to be at work until two, and I am up before seven. 

Finally, it’s time to head out to work. I’m nervous and probably should not have eaten Jack in the Box for lunch. I just love fried lettuce. I can’t help myself. 

Get to work, find the right building, and walk in for my appointment. Training on the EMR. This seems to be rather simple. I’m relieved. This is one of the hardest parts of working this way. Lots of new programs to learn. New docs and nurses. So many names and new hallways. I always feel a little overloaded and lost for a couple of weeks. 

I am never sure how much to talk. I have a tendency to either babble or sit in sullen (not intentionally) silence. This new doc seems pretty cool. 

I follow a gregarious NP. He really cracks me up. It is such a relief to be around friendly people. At my last job, I was shunned a little at first. This is so much better. 

I watch these providers carefully, sizing up their professional interactions and monitor their sense of humor. I need people who don’t take themselves too seriously. I like work to be fun. This job is hard enough without the added stress of working with pompous assholes. 

Listening to patient/ provider interactions and I feel like I could work here. I am finally back in a world where I know what to expect. Critical care just makes sense to me. The providers seem to balance the work fairly among each other. I feel like they work well as a mutually respectful team. 

This is what I have been missing. I think I am going to enjoy this assignment. I appreciate how everyone is welcoming me into the mix.

Honestly, I wish I had come here six months ago. I know it has only been one day, and it was a “easy” night, but I like the atmosphere. Perhaps the third time is a charm. We shall see. 


  I am learning so much, mostly because I know so little. Some people are hesitant to admit their ignorance about certain topics, I am not. It’s embarrassing, sometimes. 
I have never lived somewhere with a radiator. In Texas, central heat and air reigns supreme. The radiator makes strange noises in the night, if I did not know better, I would be nervous. 

Working on a surgical service is completely different than working on a medicine service. I always knew this was true, but I never really knew the surgery side of things. 

Not all residents are douchebags. You would think I would have already learned this, however most of my experience with residents has been minimal exposure. The residents I am working with are nice and quite willing to make me feel welcome. I don’t feel like they are waiting for opportunities to make me feel inadequate. This is truly a welcoming learning environment. 

Physicians are not all natural teachers, however once you express interest in their passions they will stop and spend some time explaining their expertise to you. 

I am having fun. I am exhausted by all the new ideas. 

I am still a newbie and I have a lot to learn. So excited! 

First Day Jitters

 First of all, I LOVE my apartment. It is the first floor of an old house. I am learning about steam radiators and getting used to all the cool noises old homes make in the night. Seriously, it is beyond charming. The owner was amazing. He gave me advice on local points of interest and made me feel very welcome. I could not have asked for a better reception. 
I went to bed incredibly early last night. I was exhausted from all the traveling and more than a little mind blown by all the sights. This area is beautiful! 

Getting ready for my first day of orientation. Yep, I’m nervous. What if they don’t like me? What if I’m not quite as clever as I think I am? (We all know I crack myself up on a regular basis.) Excited and nervous. I think a third cup of coffee is a good idea. 

People keep telling me they are proud of me for seeking these new adventures. I find that hilarious. I was feeling like I was behind. Somehow I should have started all this years ago. Nope. I’m right on schedule. 

Wish me luck. Cross your fingers my hair does what it is supposed to do. Let me be calm and professional. I need to keep the first day jitters down to a dull roar. Adventures are fun. It is so much more than I expected. 

Thinking Problems

imagesI may as well admit it, I have a thinking problem.

I continue to over analyze and obsess over every thing that pops into my head. I think it is because I am back to waiting to see when I am going to my new job. Waiting for licensure and credentialing to be completed is agonizing.

I hate waiting.

While I wait, I ruminate.







When is all of this angst ever productive? In my experience, never. So, why do I continue to make myself crazy? I think it may be habit. I refuse to be one of those people who rush into decisions without having thought it all the way through. People who rush into things drive me crazy. Life decisions should be carefully considered.

My anxiety about making decisions is often misguided and borders on ridiculous. By the time I am done going over my options I no longer care which option I choose. I almost always have immediate buyer’s remorse. I should have gotten the other one. I also do the thing where I can’t decide between two options and I either get both, or neither. I have to tell sales people to stay away from me when I am making large purchases. If they are over there prattling on about the features and differences between two options, I get overwhelmed and change my mind. It is really a little embarrassing.

Big life decisions about where I want to work or live are often better left to chance. I do better if I am well-informed, but then when I am going about making the choice I try to see what works out best. The problem with this attitude is I am running the risk of making a choice because it is logistically simpler. Sometimes it is because there is less paperwork involved. I hate paperwork. I don’t like signing stuff and I REALLY don’t like signing stuff again.

I am trying to learn how to back off and relax while still evaluating decisions objectively. I am still trying to figure what characteristics are paramount and which are simply preferences. Location and money are important factors but not as desirable as an excellent learning opportunity. I have not figured out a scale to measure and evaluate decision yet. I think assigning traits a weight would help more than a simple pro and con checklist. What about things that are both pro and con? How do you measure which side wins?

I even manage to get weighed down with the decision to make a decision. It is somewhat ludicrous. Here I am trying to ascertain the proper method for ascertaining what I want out of life. I am actually starting to believe the most important skill of highly successful people must be the ability to decide and follow through with their decision. Where do you learn that skill?

So, where is the delineation between purposeful consideration and needless obsession? How does one go about making a decision and standing behind it with confidence?

Most importantly: How on earth do you make your brain turn off for a little while so you can get some sleep?

I am Lucky and Working Holidays

Hospitals do not close for the holidays. This means healthcare providers have to spend time away from their families and go to work. I have never minded working holidays. To be completely honest, I consider it a privilege.

When patients are in the hospital on a holiday, it is the last place in the world they want to be. We do not typically schedule elective procedures during those times. The people who have to be admitted usually have no other option.

I do not see any point in refusing to work on a holiday when we celebrate locally. I can go spend a couple of hours with my family or even celebrate another day, it is not a big deal to me. My family will fix me a plate, or even send a huge spread of food for me to share with my coworkers.

Christmas Eve of 2013 I was at work in the MICU. The unit was full and we were slammed when I get a phone call from my mother saying my brother, sister-in-law, and two nephews were in a bad car accident outside a small town about two and half hours away. They had been traveling to visit her family. We were not able to get much information about their condition over the phone and my sister-in-law had already been transferred to a larger hospital.

I dropped everything and went to go take care of my family. That drive was so long and I have never been more desperate to get more miles between me and Lubbock, Texas. I had to get to my brother and my nephews. When I finally arrived to the hospital, my nephews were in a hospital room filled with toys. They had been doted on and loved by so many people. Someone had gone and bought them some clothes to change into because theirs were dirty. DPS had brought them teddy bears. I believe it was a nurse’s aide who went and bought them cars and trucks from somewhere. I have never been more grateful. My boys were okay.

Christmas that year was terrible. My brother could barely move and could not see due to his injuries. His wife was in the hospital preparing to have the first of many surgeries. The boys were very stressed out, although physically they were okay. I would have much rather have been able to work that holiday.

My family is okay if I am working. There are no big personal tragedies or crises. I can focus on my work because my family is safe and healthy. If I have to leave work because someone is hurt or sick I am a mess. Work is so much easier. Once the day is over I get to go home and escape whatever nightmares transpired at the hospital.

I can devote a few hours to another person who is having a bad holiday due to their medical condition. I can spend time with a family who is saying goodbye to their loved one on that day. It is the least I can do. I did not lose my family when they had an accident on Christmas Eve. We were lucky.

My role as a healthcare provider is important to me. It is humbling and I am proud of the career I chose. I have worked hard to be able to help people. I sacrifice a lot of time with my family and friends. I work long days and some days it is so hard.

However, I will keep working holidays. I will do my best to provide care to my patients and their families when they really just want to be at home celebrating. It is my way of showing my gratitude for my good fortune.

If you find yourself or your family in the hospital on a holiday, I imagine there are more people who do not resent caring for you. If their family is like mine they will be gracious and understanding of the service we provide in our professional lives. We adapt and adjust our plans so we can be of use. Don’t worry, we are not being left out of the festivities. If we are lucky, we are good friends with our coworkers and they have become extended family anyway. It is the least we can do.