Day 15

I’ve been up here in The Empire State for 2.5 weeks now, and I think I am probably changed forever. I am learning so many things about myself. I have new concerns for my patients. I am afraid of exposing them to a virus if they do not already have it. I am also afraid of leaving them afraid and feeling isolated even after I see them. It is hard to comfort people when you are trying to maintain a safe distance from them. 

I am also learning to communicate with stressed out family members who are feeling neglected and ignored because they cannot be at the hospital. When our loved ones are sick we want to be there to take care of them and we are unable to allow visitors. I cannot even imagine what it is like to be sitting by the phone wondering what the hell is going on at the hospital. I know my imagination tends to run wild when I cannot be there. I can’t imagine what it would be like during this time. I am trying to make plenty of time to reach out and give these families the support and care they need as well. 

All of this is stressful and it is easy for me to become mired in self-pity and to feel like it is all too much. I have to remind myself that I am one of the lucky ones. My family is safe and sound at home. 

Speaking of lucky, I got presents! A dear, sweet friend made me some beautiful scrub caps and I am already feeling even more loved and cared for than I usually do. Our friends and family are the reason we can keep doing these jobs. They remind us to keep fighting and provide us with the support we need to overcome our fears and self- doubt. When I find myself feeling inadequate and wonder what I am doing all I have to do is think of all the people who believe in me. 

It is so easy to fall into the trap of negative self-talk. When I am frustrated I tend to take it out on myself. I wonder why I cannot be better. I wonder why I do not know all the answers. I convince myself anyone else could do a better job than I am doing right now. I ask myself just exactly who do I think I am and what makes me think anyone would trust me to take care of their loved one. That is a dangerous place to live in for very long. It is also not true. 

Not that I am special, but I know how to take care of patients. I have been taught by the best of the best. I went to one of the best nursing and NP schools in the country. My mentors have all been phenomenal and they have taught me the skills I need to provide excellent care. 

My fears are healthy as long as I keep them in perspective and use them to make sure I am constantly evaluating every situation and looking for the best solution. Staying humble allows me to ask for help and recognize my own limitations. This is why I am good at my job. I am not afraid to ask for help and this is a strength, not a weakness. 

I do not know what the future looks like. None of us do. We all need to keep our wits about us and just keep doing the next thing when it comes up. We will make it through this because we are able to adapt and change. This is our gift as a species. We all need to be prepared for things to change and to be willing to change along with each situation as it arises. We need to protect and love each other. I am so grateful to know I am loved and I get the opportunity to give something back to others. It makes me feel useful. 

Today is a better day. Wish me luck and remember to take care of the ones you love. We all need support right now. These are scary and hard times. I feel like we can make it through though. 


I get it. We are all frustrated. People are out of work. There does not seem to be enough money to go around. Poor people are suffering. 

I keep seeing the most ridiculous posts on FB. People insinuating the virus is a made up hoax. People spreading posts about how this is all a money grab by hospitals. People saying social distancing is worse than the virus. There are even videos by nurses (or so they say) claiming patients are being murdered by their healthcare providers. 

Are you kidding me? 

I got up here a week after things had started to calm down a little. The stories I have heard have scared the hell out of me. They describe it as a tsunami of COVID patients. Young and old alike. Nevermind about all the other sick people. 

I am so angry people are spreading this rhetoric. If you honestly believe your doctor and nurses wish to harm you in order to make some money, you need to find a different doctor. 

The reason people need to stay home and try to avoid spreading this virus is simple. THERE IS NOTHING WE CAN DO TO TREAT IT! If you are lucky, you are either asymptomatic or have mild symptoms. If you are still lucky, you feel like you have never been sicker and spend two weeks in horrible pain and wondering if you are going to die. People who end up in the hospital, but manage to recover are STILL lucky. 

There are a painful few who survive once they require a ventilator. Those folks are still lucky. If you are unfortunate enough for your heart to stop because it is starved for oxygen, or you throw clots all over your body, there is not much we can do to help you. 

Nurses, doctors, CNAs, Rad Techs, RTs, housekeepers, food service workers, everyone in the hospital is putting their life and safety in peril to help people everyday. They have families waiting for them at home too. Many of them have underlying health conditions, and yet here they are… trying to help you. 

In many states healthcare providers can be assaulted by patients and have no legal recourse. We are literally putting our health and safety on the line every single day we go to work. I am not asking for accolades or cheering, all I want is for people to use some common sense before they spread false information. 

Yes, the information we have about this virus changes constantly. This is because we are still learning about it. It is brand new. The way we treat it changes. The things we know about it changes. Stop blaming the people who are doing the best they can to treat patients and to keep the public safe. 

I promise you, this virus is so much worse than you believe. Wear your mask. Stop bitching. Try to follow social distancing rules. You do not want to see what happens when your entire city is overrun. You want to have a hospital available to care for you. You want to have your minor heart attack treated so you do not end up with permanent damage. You want to get treatment for that stroke before you permanently lose the ability to speak. You want to get that cut sewn up. Trust me. We need our hospitals to be functional. They won’t be if we get hit by this tsunami. The people of NY did not expect it to be this way. They did nothing to deserve this. We don’t want to be next. 

So, today I will go back and work another 12 hour shift. I will wear a mask sent to me by friends. (These healthcare providers are only given one a week.) I will wash my hands and try to remember to keep my hands out of my eyes. I will continue to try and keep 6 feet away from everyone. I do not want to spread the virus to people who do not already have it. I am counting on the rest of you to help by using common sense and a little decency. If you can’t do that, I will still take care of you. My friends and I will still put our safety on the back burner even if you cannot try to protect others. We won’t even hold it against you. So, please just remember who you are accusing when you share those hateful videos. 


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 Dreaming

Today I managed to sleep most of the day. Still having terrible nightmares, but I am feeling better during the waking hours. A friend texted me to keep writing and connecting with other people and I think that is probably the best advice I could have been given. Got another box of presents! Tide, masks, an umbrella… plus Amazon sent me granola bars. I would say that is a good day. Especially when I also got some goodies from a friend last night. 

I never would have dreamed that people thinking of me and reaching out to send me stuff would mean so much. It makes me wonder why we don’t correspond more by mail these days. Maybe we should start. Just a postcard. Or a little note scribbled on a scrap of paper. What if we actually invested in nice stationary and spent some time writing letters? Anyone want to start doing that? Just a thought. 

So, I bought a Hobonichi planner for this year and I am using these daily pages as a sort of artsy journal. Not that I have a single shred of artistic talent, but I smear some watercolor on the page or tack down a momento or a photo in the mornings before work. Nothing special, but I am enjoying it. One reason I do not like to scrapbook is there is too much pressure on making everything perfect. There is nothing about my life that is perfect. It is all wonderfully messy and I like it that way. Does anyone else do something like this? 

I have decided that once all this is over and I take some time off for some R&R I am going to the beach. I plan to sit by the pool under an umbrella with my stack of books and drink the cocktail of the day. I will make no decisions except which swim attire to wear. I will only read novels and short stories. I do not want to think about anything important. I just want to relax. 

Tonight is day 10. Hoping for a good night. Maybe I can make some new friends and find someone to have some laughs with. So, my goal for tonight is to find at least one person with an incredibly sick sense of humor and to make friends with them. Wish me luck. 

Different Days

Lovely physician I am working with- improvising a scrub cap. I think it is adorable.

Today, well actually tonight, I am working my first night shift. Hoping it goes well. 

I forced myself to stay in bed today so I can be at my best tonight. Going back and forth between days and nights is awful, but it is what I need to do. I think it will be okay. 

Mail is exciting when you are far from home. Today I got a package from Amazon. I was excited to open it. It was Downey wrinkle releaser. Still exciting. Not quite as exciting as my Scribe delivery or Magnolia deliveries that come to the house, but still it is like getting a present. (Presents are nice even if you send them to yourself. Some friends are sending me some PPE and some masks and caps. I can’t wait to get them. It makes me feel close to people even when I am a little isolated.) Still kinda wish I could get a hug from someone- but that will come eventually. Maybe when times are better. I did order a small Bose speaker to have for when I travel. I got the email that it is being shipped today. I can’t wait for it to arrive. I need some quality tunes! I miss live music. My memories in FB are full of fun adventures. I guess April is always a good month for me. I miss Jazzfest. 

Time for the real stuff. I am having terrible nightmares. I read somewhere this is common for lots of people right now. My dreams are excruciatingly bright and vivid. I wake up with my heart pounding and feel like I have been beaten in my sleep. They are all about running and hiding from something unseen. Guess that is not surprising given the current state of our world. Trying to remain optimistic and to keep this all in perspective. Times are hard for us all. 

I am lucky. I am in New York, but a bit outside the city. I have a hotel room that is bigger than my first apartment. I think that is helpful. I do not feel closed in. I have enough room to relax and have separate space for sleeping and all the other activities of daily living. 

This is a hard assignment. I feel a little lost and do not get much feedback, but I think I am doing okay. 

These days are hard and not knowing how all this is going to turn out is even harder. I suppose going into NYC and working ICU or something would have been more exciting, but they need help in lots of places. I can leave the exciting jobs for other people. 

I miss getting to know my patients and their families better. That is one of the perks of being a healthcare provider. Now the patients are isolated and their families are barred from the hospital. I know it is safer this way, but it feels wrong. In trying to keep ourselves and others healthy we have to keep more physical distance than I am used to. Remember back when Princess Diana was photographed hugging the lepers? I have always been quick to hug my patients and their families when they needed it. Now, I do not even shake hands or touch them if I can keep from it. I do not like it. I do not like being afraid to touch people. 

Distance is hard when you are trained to care. 

These are different days. 

Doing my best to keep my spirits up and to be useful. 

Hope you are all doing well. More later. 

Day 5

Day 5

Of course I woke up an hour before my alarm went off. It only makes sense for me to be awake while the rest of the world is tucked away in their beds. I don’t know what they are dreaming of- but I am haunted by anxiety and images of a post apocalyptic world where we never see a smile again.

These masks are hiding the fastest way for us to share our social distancing humanity. I suppose I can only hope my eyes are sending kind messages.

I am struggling a little to figure out how to best be of use. I am doing my job to the best of my ability and I am struck by feelings of inadequacy and fear of missing something important. This is the hardest part of working in the healthcare field. I don’t have any magic answers and don’t believe anyone else does either.

I guess this is the problem with a “novel” disease. It’s brand new and quite frankly I think he is an asshole. I do not think he is a wild animal to be domesticated, and I can only hope he mutates down into something akin to our less virulent influenza strains. Do the virology experts have nightmares about these boogers too? Maybe their knowledge gives them some peace, although I suspect they know more about these microscopic demons and have this feeling of dread as well.

So, even though I am pretty much wracked with a sense of unease, I have to focus on what I can do. I can take care of my patients and the people I love. I can look for solutions and educate myself. I can be a good example for others to follow. Hopefully that will be enough.

I try to dedicate my life to being useful. I want to know I have done my best to be a good citizen and member of society. I do this by doing my job. I look for ways to be of service. I try to the best I can with the tools I have available. Maybe that is all any of us can do.

In the words of the Red Hot Chili Peppers … “these are the melancholy mechanics of my mind…”

So, We Laugh. 

Wait a second. What is happening? Is this really happening? Now? With all these people watching? What do I do? What did I do to cause this? Oh my God, what will people think? I don’t want to be the bitch who causes a scene. Maybe if I just stay really quiet and still this will stop. Why are you massaging my shoulders? I don’t like it when anyone does that. Oh, what the hell? What are these nurses thinking right now? Do they think I want this to be happening? Can they see the shock and horror on my face? Do I want them to feel sorry for me? Can I just play this off as a weird joke? Am I overreacting? Is this okay? Why do I feel so weird? Is it odd I am a little scared? This just took a very bad turn. Maybe it’s okay. He doesn’t mean anything by this. Who am I to assume this is anything unusual? I don’t want him to hate me. I just want to fit in. I just laugh nervously and catch the charge nurse’s eye. She is not surprised. 

We laugh about this situation several times over the next couple of days. The next time it happens I am a little less shocked, but even more uncomfortable. I feel like I should say something, but I don’t know how. 

He’s MARRIED. He’s basically my boss. He would not be doing anything that is inappropriate. What kind of person misinterprets someone just being nice as something sexual? I am the one who is unprofessional. I’m not the kind of girl people randomly pursue anyway. I need to chill. Besides, no. Not ever in a million years. 

So, I laugh. 

I laugh about it with the nurses. They regale me with other shocking stories and examples of bad behavior. The doctor that asked the nurse to help him diagnose some problem with a patient’s penis by googling images and having her look at them with him, nevermind that he draped his arm around her shoulder.  Hang on. WHAT? How can he possibly think that is okay? How socially blind can you be? Cues! Can he not see the cues? Maybe he really did just want some help figuring out the diagnosis. I’m sure he meant nothing by it. He’s just a gigantic dork. He didn’t get many girls in high school. He doesn’t know. 

So, we laugh. 

We ignore the vaguely threatening tone when he discusses issues with us. “It’s a friendly chat.” He is on our side, as long as we a team player. He just wants to reassure me that we all want the same things here. This conversation can stay between us.  What happens when I tell you to leave me alone? Professional development should not have to be a secret. 

So, we laugh. 

You can tell the laughter is masking something else. I wonder if part of it is fear. 

As healthcare providers we rely on our team. When people like us and think we are fun to work with, the day is so much better. We depend on inappropriate humor to shield us from the horrors of our work lives. We spend more time with our colleagues than we do with our family and friends. We don’t necessarily want to maintain strict professional boundaries at all times. We need and want to be close to our work family. The lines have to be blurred. Does this mean we can’t stand up for ourselves? 

Nobody wants to be the uptight bitch who tattles about trivial things. We don’t want to be the narc who doesn’t sneak drinks to the nurse’s station. We would never dream of reporting someone for playing on their phone during a rare moment of downtime. The rules are made to be broken. 

So, we laugh. 

Sometimes we need physical contact with our coworkers. Sometimes playful banter (even wildly inappropriate banter) is what gets us through the day. 

So, we laugh. 

We all know how bad it can be if the people we work with or for do not like us. They will find fault with every decision we make. We will be written up for every infraction of “policy.” It’s easy to get rid of the people who don’t fit in. 

We need them to have our back when there is conflict. We need a resource. We are dependent on them for security and protection from other providers and even sometimes patients. 

So, we laugh. 

We don’t speak up when someone violates our personal space. We allow people to touch us in a way that makes us uncomfortable. We smile and pretend it doesn’t bother us. 

We don’t tell someone we are not comfortable perusing photos of penises with their arm around our shoulders at the nurse’s station. We sit there and wonder how we got into this situation. 

If we don’t laugh, it could mean this is serious. It could leave us feeling vulnerable when we are already in danger every day. If this isn’t funny and no big deal, it means it is hostile and we are victims. 

So, I am afraid we will continue to laugh. We will train our new nurses to allow “friendly” assaults on our bodies. After all, we are all on the same team. 

I am only a nurse practitioner

As I walk through the side entrance of the hospital, my white coat flapping in the Texas breeze, I am quiet and introspective. What will the day hold for me? Do I have the knowledge and skills necessary for assessing and diagnosing my patients? Will I know the current evidence based guidelines? Am I good enough to do this job? 

When my patients enter the hospital, they have a problem which is causing them physical or psychological distress. They did not come into my professional realm for a social call, they need me to intervene and fix the problem. Usually, by the time they are admitted to the floor, they have already been examined and assessed by a physician in the emergency room, and it was deemed necessary to admit them to the hospital for further evaluation and care.

I look over the information obtained in the ER and try to come up with a list of questions I need to have the answer to. I have to evaluate past medical history, family history, personal habits, current medication, and finally complete an interview which is followed by a physical examination. Sometimes, if I am lucky, there are symptoms and risk factors that are glaringly obvious and I know an effective treatment for the malady. Other times, most of the time it seems, I am handed a vague list of complaints which fail to give me a concrete diagnosis. Now, I have to evaluate the things I cannot see with the naked eye or hear through my stethoscope. Subjective complaints are the most difficult to assess. Is the patient telling me the entire story? Are they being truthful? What am I missing? How do I get more information? How can I get this quantified? Is this part of the story pertinent? What else do I need to know? How do I avoid offending or embarrassing this person that came to me for help? How do I bring up sensitive topics? How do I reassure this person that I care? How do I facilitate communication, while using time wisely?

Now, I am not usually seeing only one patient at a time, and all the information I need is not handed to me in a nice little package. I am waiting for diagnostic results and other professional opinions. I am also juggling the needs of the hospital, insurance regulations, personalities of the patients, their loved ones, other hospital staff, and a ticking clock. I make a decision based on the information at hand, and I have to trust my skills to obtain all the information.

I have taken my time to listen to the patient, asked invasive questions meant to probe and uncover the secrets their body keeps hidden in a shroud of mystery. I explain my plan of care and explain the results I am seeking from my interventions. I walk out of the room and sit down to record in the official medical record my findings. I have to maneuver my way through an electronic medical record that seems to have been designed to make finding the details of care difficult to find. I am granted peace and quiet, and no one ever interrupts me and breaks my train of thought. Oh, wait that is not true. I am constantly bombarded with questions and requests for my time, attention, and energy.

Constant terror that I missed some potentially fatal condition, or that I will not order the proper intervention or screening lies just under the surface. I find myself double checking and reviewing medications and test results. I discuss the case with my supervising physician. I waiver at times in my resolve. Then, I have to make a decision. I find myself reviewing the case with other members of the health care team and asking for their insight on the patient’s condition. I attempt to make sure the nurses concerns are addressed. I seek to educate and give them insight to the rationale for proposed treatment. I have to give them options and hope they are agreeable to the plan. I have no power to force compliance. So, my argument had better be convincing. I have to be able to communicate with people regardless of the language they speak, their cultural biases, and their education and intelligence level. I have to provide care that is accessible to everyone regardless of the barriers to knowledge. I have to find a solution for any roadblock. This requires extensive knowledge and comprehension of an unending list of resources and rules for utilization. It also requires the ability to overcome whatever social issues arise. I am tasked with having difficult conversations, while maintaining a professional manner.

One of the biggest issues I face is discharge planning, which actually begins the moment a patient enters the hospital. What has to happen in order for the patient to be deemed stable for discharge? What kind of follow-up care will they need? How am I going to plot a course of improved health for this individual? What are the financial implications? What resources are available? What are the rules for the care I seek? How do I properly justify medical necessity?

Oh! Don’t forget patient satisfaction scores affect every thing I do. If the patient is not happy with the proposed treatment, or if they feel something else would be more enjoyable, they can affect the amount of reimbursement the hospital receives in the future. How do I satisfy someone when they are sick? How do I explain the difficulties with pain control? Is it my job to somehow make you pain-free, when there is some part of your body malfunctioning? How do I make the patient understand they have to get out of bed when all they want to do is sleep through this process? How do I make them happy about the dietary restrictions for their particular condition?

Sometimes, I go and speak to a patient and spend a considerable amount of time with them, I explain my role and that I am going to be providing their medical care. Yes, I am operating under the supervision of a physician, and I would not have it any other way. After I have gone over every thing and I have documented the encounter adequately, and met with all the members of the healthcare team, I hear this statement, “The patient and their family are upset because no one has talked to them today.” I am sorry, but WHAT? I just spent an hour with this patient and their family IN THE ROOM. This is not including all the time spent with care coordination and other necessary actions. OH…. you want a DOCTOR. Okay. No problem. Now, I have to approach the physician who I have reviewed the case with, assured them I have it under control, and review and recap the entire case, explain exactly what I have done, and reiterate the entire conversation I had with the patient and the family. The doctor walks in the room and spends a couple of minutes, and magically every thing is right with the world.

I am left feeling moderately unimportant. I have spent time to pull up a chair, listened compassionately, and truly worked so hard to take good care of you. I feel like all of my hard work was for nothing. The patient and their family were not pleased with my efforts. They wanted a doctor. I get it. I really do. The problem is… if I am being honest, at times it hurts my feelings. I know it shouldn’t. I am able to think through it and brush it off, but I am left with a little bruise on my ego.

You see, I am only a nurse practitioner. I am not a physician. I am competent to provide medical care, and I know my limits. I have no qualms with admitting when I do not know the correct answer, and I am not afraid to ask for help. I crave and value the education my supervising physicians provide for me on a continual basis, and I am never offended when they provide alternative treatment plans or point me in a different direction. I am a physician extender. They are ultimately responsible for the care I provide. I respect that role. I respect my role.

I work hard to gain new information and to learn more about caring for patients. I like to gain new understanding from other specialities perspective. I look up the things I have never heard of or don’t particularly understand. I am exquisitely curious, and I am driven to constantly be better. My professional goals center on providing the best care possible for the patient. I am here to provide safe, competent medical care.

Due to my professional path, I am still a nurse. I have a complete grasp of the realities and responsibility of this role. I was also a unit secretary. I understand the complexities of the relationships between all the people on the team. Sometimes this is a hindrance. I held myself to high standards, and sometimes I find myself judging other people as harshly as I judge myself. I have to work continuously to encourage and promote open lines of communication. I want the other people involved in providing care to feel they can come to me with any issue or question that arises. This is difficult at times because I am entrenched in my own inner battle with my own insecurities.

I am not certain if the fear of making mistakes is normal for all healthcare providers, but I believe this fear keeps me on my toes. The balance between humility and confidence is sometimes difficult to achieve, and I fear I may fail to provide the necessary reassurance that I will do every thing in my power to meet your needs. It is difficult to be confident when every thing is so gray. I think this may be one of the most difficult parts of my job.

I have learned healthcare providers are just human. We are attempting to unlock the mysteries of your body, and there are infinite factors that must be considered. We are bound by limitations of medical knowledge, as well as the logistical nightmare of resource utilization. We can offer suggestions and proposed treatments, and we can attempt to forecast the results of those treatments. However, we are left powerless as to the actual outcomes. We do our best. We do what has worked the best in the most number of people possible.

Nothing is guaranteed, yet we are held responsible for the end result. If you live, God saved you. If you die, we killed you. This is a huge burden. The emotional toll it takes on me when there are bad outcomes has to be faced head-on. I have to process the feelings, evaluate the situation, and hopefully learn a lesson. Sometimes the lesson is simply a reminder of human limitations and the fact we are all mortal.

So, I live in constant fear and feel an enormous amount of obligation to provide the best care for my patients. I have to push my ego aside and bury my pride. I have to portray myself as competent to facilitate confidence in my abilities. I have to remember my limitations, while simultaneously trusting my skills and intuition. I will chase every resource available to improve your health or quality of life. Sometimes, the patient or their family’s wishes are in direct opposition to the best treatment. We are tasked to keep someone alive on life support when their quality of life is dismal. Or, we keep providing measures that simply prolong suffering when there is no chance of survival. These cases are distressing. Running a code on someone when in reality further care is futile seems like torture. However, we are not in charge of what care the patient receives. We offer advice and suggestions, everyone is allowed to make their own decisions. It is difficult to keep every thing in perspective when we are held responsible for the outcomes when the proposed plan of care is not carried out or the patient refuses to comply with instructions and advice.

Please do not forget the required tasks involved in maintaining licensure, hospital privileges, and employment. I have continuing education, certifications, privileges, and meetings I am required to attend. I have to juggle the business of being employed with providing patient care. I have to put my personal life on hold, and out of mind while I focus on life and death issues. I also have to make time for the people in my life who need me to be there. I cannot be preoccupied with work stuff. The amount of compartmentalization required to be a healthcare provider is enormous. I have to remind myself to put work on a shelf sometimes. It is difficult to not be consumed by it all. 

Please, just remember: The physicians and other members of your healthcare team are only human and we cannot perform magic. We do the best we can. I have to be remain constantly vigilant. After all, I am only a nurse practitioner.

Your Nurse Practitioner is only human…

  I may have underestimated the power of human connection. As a Nurse Practitioner, I am fortunate to get to meet and know so many different people. You can try all you want to keep an emotional distance. You can attempt to maintain “professional boundaries.” You can almost convince yourself these patients and their family do not affect you.

Sure, this is reasonable. It is all about self-preservation. You have to be able to leave work at work. Otherwise, you would be entrenched in stress and grief all the time. I have to be able to laugh while I am at work. I cannot allow myself to be mired down in the misfortune of the sick and suffering. I am not only a Nurse Practitioner, I am also human and I cannot help but to forge a connection with people.

It may be your wit and charm. Perhaps you told me a dirty joke I was not expecting. Your face may light up when you talk about your children and grandchildren. It does not matter what causes me to allow you into my heart, it just happens. We are humans.

When I am at work, I pour most of my energy into evaluating what you may need. I am filled with self doubt, so I agonize over every decision. (Well, as I mature and have more experience the agony is decreasing.) I hold myself to nearly impossible standards. Sometimes I am inexperienced in your particular condition. The panic sets in and I have to start reading. I rack my brain and try in vain to remember everything I have ever heard about this situation. I do not take my ignorance or inexperience lightly. I ask questions and I am very forthcoming about my need for assistance. My ego is not so fragile that I can’t ask for help. I work hard to remain teachable.

Keeping in mind when I am at work and I make a mistake, the consequences can cost lives or cause irreparable harm. I am invested. The boundaries have to be blurred a little. This makes it difficult when a patient is not responding to the course of action we have laid out. It is especially hard when we run out of tricks to try. Sometimes there is nothing we can do. This is the hardest part of my job.

Now, if you come to me looking for answers and I reach out to the experts and there is nothing else to be done… what now? I don’t get to sign off and retreat back into blissful ignorance. I am now tasked with explaining the situation and helping you decide on which actions are appropriate for further care.

I find this job especially cruel when I think you are going to do well. I see initial success in our last-ditch efforts. The Hail Mary pass seems to be working. Then, despite the successful catch, we fumble the ball. I am going to scramble to try to recover it. Sometimes the damn ball just disappears.

This is the worst part. Dying is part of life. We are all going to die someday. Yes, we can try to help people live as long and healthy lives as possible. There is going to come a time when I have to be willing to sit with you and discuss whether or not you want to continue aggressive medical care. If you tell me you are done, I have an obligation to honor wishes and to support your family through that transition. It goes against every thing in my heart. I want everyone to live happily ever after.

I can try to have boundaries and walls. I can try to keep work separate from real life. Sometimes, I will fail. In order to heal from this grief, I have to acknowledge I am experiencing it. I have to allow myself to feel. I do not want to become a cold, unfeeling person. This opens me up to heartache. I am okay with that. It also opens me up to feeling sincere joy when my patients do well. It is not all just another sad day, there are lots of victories. I get to feel them too. Yeah, it is exhausting at times. It is hard. I would not want it any other way.

I am not one-size fits all. Not even close

I have said it before. I will likely say it again. I am fat. Now, there are people who try to say things like:

“You are not fat. You have fat.”

I hate that. It makes me roll my eyes and want to scream. Give me a break. I am not in the mood to argue semantics. Do not undermine my intelligence by trying to put a positive spin on a potentially lethal medical condition. I deserve better than that. You deserve better than that.

Obesity is a medical condition. Morbid Obesity is a serious medical condition. I have that. It does not make me less of a person. It does not mean that I have zero self-worth. This is not some body dysmorphia issue. It is a medical fact. Here is the caveat. I am responsible for treating this disease.

For me, this is not due to something out of my control. I have made poor life-style choices. I ate junk food (I still do sometimes.) I have not been active enough (I am a little better, I need to work harder.) I did not put my physical health and well-being as a priority. Once again, this does not make me a bad person. Stop making excuses for me. I can do that all on my own.

As a morbidly obese nurse practitioner, I find the whole weight loss topic difficult to broach with my patients. I feel like I have no right to tell them what they need to do in order to get healthy. I am actually afraid that they are going to challenge me and ask exactly who I think I am? Well, let me tell you. I am an educated medical professional who has an obligation to try to help you achieve health and wellness. When I avoid this topic, I am not preserving either of our best interests. I am doing you a disservice.

I do not hesitate to admonish a patient for smoking, not taking their blood pressure medications, or not taking care of their diabetes. I lay out the worst case scenarios, and do my best to convince them that “you could die!” I ask questions to find out what the barriers to compliance are, and I try to help them find the tools they need to be healthy. So, why do I avoid the topic of weight loss? Why do I avoid asking them if they need tools to get healthy?

I have an obligation to be open and honest with myself, and my patients. I need to step up and take the time to find out why they struggle with living a healthier lifestyle. I never hesitate to make sure that my elderly patients who are losing weight have enough to eat, and to inquire about who helps the ones with mobility issues get their needs met.

I am not insinuating that I know the best method for everyone to lose weight. I am not insinuating that everyone who is overweight or obese is going to die. I do know without any reservation that there is no such thing as morbid obesity being healthy. Even if you have not developed any obesity related complications, I assure you, you will.

As a medical professional, I want to see my community thrive. I want to improve the health and wellness of my community as a whole. I want to improve my health and wellness.

Starting to workout and eat right is a daunting task. You feel isolated. You feel like you are on display. People do not hesitate to walk up and exclaim “OH MY GOD! How much weight have you lost?” It makes you feel like you are just a number. My self-worth has nothing to do with how many pounds I have lost. I get more satisfaction when I do something active that I could not do before. You are embarrassed when you are wheezing and out of breath after 5 minutes on the treadmill. You are going slower than anyone else. You do not belong.

This is why I think that promoting a community walking program will be beneficial for my town. We can promote activity and healthy lifestyles in a nonthreatening and fun way. We can help people with goal setting, and then help them on their journey to meet it.

So, I want to start a movement movement. I want to encourage and support people on whatever step of their journey they are on. I want everyone to have resources for their questions, and a safe place to voice their concerns.

I want to foster a community of encouragement and I want people to have somewhere to celebrate all their milestones.

It’s way more fun to workout with friends- and it makes the selfies all the more epic.

I used to tell myself that I needed to lose weight so that I could work out. Does that make a bit a sense? I felt like I did not deserve to be helped. Everyone deserves a little help. Maybe all they need is a safe place, reasonable goals, and a few friends.