5 Surefire Tactics to Take Full Advantage of the Daily Commute

November 6, 2015

One of the main time-consumers of our day, with the exception of deleting countless e-mails, would have to be the daily commute. Whether it be in your own car, the subway, a train, or otherwise, the amount of time we spend waiting to get to where we need to go averages 26 minutes one way for the typical American commuter. This inspires optimistic creativity – to determine the best way to optimize our time on the road in a safe way. It also inspires math calculations – even for a science major.

26 minutes x 2 = 52 minutes per day

52 x 5 days a week = 260 minutes per week

260 x 52 weeks = 13,520 minutes per year

This roughly equals 225 hours or 9.4 days per year of our lives commuting. And that is for the lucky ones only driving 26 minutes each way (JEALOUS!)

Disclaimer: The last time I took a math class was freshmen year of college at Florida State University (GO NOLES). It was a statistics class and I got a B-. The class was early morning with a horrific Monday, Wednesday, Friday schedule. The majority of college kids would tell you this is the absolute worst course schedule ever. Perhaps If I had attended on the regular, the grade outcome may have been different.

Anyway, I digress. The point of the above blurb is: CHECK MY MATH.

In my continual attempts to make my day-to-day activities better, much better, I have paid a great deal of attention to how I can optimize the time spent in the car. Listed below are my findings.

  1. Find 2-3 podcasts that inspire you and listen to them consistently. When I search the podcast app for areas of interest, I also pay attention to the # of podcast episodes already available, user reviews, and of course – the subject matter. Using this highly complex equation as well as suggestions from friends, I have found podcasts that have replaced the t.v. show “Friends” as my daily guilty pleasure. However, not so guilty if they are teaching me new and helpful concepts!

The take away from #1 – take this time that is typically spent in autopilot mode and utilize it to get better at whatever you are striving to improve on.

  1. Practice mindfulness. Is this a buzz word yet? Because it should be. It means to LIVE IN THE MOMENT AND BE AWAKENED TO YOUR CURRENT EXPERIENCE. You’re like “ummm… embrace traffic jams?”

I don’t have to tell anyone, we live in an overstimulated world. Learning to be mindful of our current situation is a lesson we all can benefit from immensely. While you are sitting on the subway or driving in the car, practice being mindful of those around you. You may surprise yourself. You could potentially avoid many an accident or help a commuting neighbor in need.

 Perhaps an equipment-juggling dad dropped his sunglasses in the road while loading his baby into the car at daycare pick up and didn’t notice. You could be that very nice person that ran across the parking lot in the rain to save them for him. (my husband says “thank you, nice stranger”, by the way).

  1. Use this time for taking deep breaths. Did you know that when we do this, our heart rate slows down, our blood pressure can decrease, and it physically aids in our “rest and relax” body system activation. Sure sounds like something we need on the road. This Harvard article recommends we aim for 10-20 minutes per day practicing deep breathing. Hey, that seems to fit into my math above.
  2. Pray to a higher power. Whatever that may be that you believe. I have personally found this to be a wonderful start to the day, beginning prayer as I leave our neighborhood. Starting the day with a verbalization of what I am grateful for, thanking God for my many blessings, and asking for his guidance has provided a tranquility and inner peace that requires continual renewal in life.

If you chose to do #4, please do so with eyes open on the road. Just sayin’.

  1. Work on your posture. I don’t know about you, but I hunch over way too much, particularly in times of stress (think: post work commute). This posture is terrible for my back, making me more prone to injury, particularly in my neck and shoulder region. We are more likely to practice poor posture during this typical time of zoning out – therefore, it behooves us to practice the exact opposite and work to improve our posture at the wheel (or in our train seat, etc.). Ensure you are sitting straight up with proper alignment, head directly over your body, shoulders back, hips aligned with the body.

So there you have it. 5 simple ways to improve your commute by improving yourself. It sounds like a win against the road to me. As you incorporate these practices into your daily routine with your own individual tweaks, it will truly help you optimize your time on the road in a safe and positive way.

Here’s to a Better. Much Better. Drive!

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Why You Should Always Bring a Loved One to the Hospital

October 26, 2015

Nobody wants to think about it but the vast majority of us WILL require a hospitalization at some point in our lives. Maybe it is a quick day stay for toe surgery or a colonoscopy. Maybe the only time you’ve ever been a patient in the hospital was to have a baby and go home 48 hours later. Typically,  if you are very blessed, being admitted to a hospital system is an exception to the rule. Our goal is to stay out of there!

For many, this is a far more complex challenge. People live every day with chronic conditions — meaning, they don’t go away. They aren’t cured. Often times, these conditions flare up or cause infections, severe pain, complications that must be addressed and stabilized in the hospital.

We also get into accidents. Our kids cut their fingers, bonk their heads. We injure ourselves performing one of those “simple” do it yourself projects we see on Pinterest (damn you, mountable, rustic bird house!!)

This means — GULP — we must seek medical care. And when we do, a massive chain of events spiral into action before we even realize what is happening (because we are the ones injured, after all). I will tell you as quickly as the next provider, our healthcare system is far from perfect.

It is flawed, BUSY, complex, confusing, frustrating. Is it one of the better ones in terms of patient care in the world? I think so. Would I prefer to be treated here compared to many other countries? Absolutely. But, as you are well aware, we have our issues.

*COUGH* Personal accountability *COUGH* Major abuse of the system *COUGH* People with jobs paying a whole lot more for healthcare than those that do not work or “can’t work”.


Uff Da! (Norwegian expression for sensory overload — exhaustion — dismay)

Sorry, let me clear my throat. I caught my child’s cold and a symptom of it is digression.

Anyway, one of the most important actions you can take when accessing our healthcare system is:

Bring someone who loves you to the hospital.

 Below are my observations:

You can’t retain everything. You only have one head. There is a dump truck full of information that gets unloaded onto you when you receive a diagnosis, discharge instructions, a new medication. One cannot possibly absorb it all in the midst of recovering from an illness or injury. Your brain is already working feverishly to recover from the stress of sickness.

 You won’t remember the whole story. Or, you may not choose to tell it. Have you experienced what I like to call the healthcare version of “Ask 20 Questions”? It’s more like “20 Providers Ask the Same Question”.

“What brought you to the hospital?” rolls into a complete interview of many components that includes your recent history, full medical and surgical history, social history, family history, etc. Your ability to retain and regurgitate these crucial pieces to your diagnosis puzzle is again compromised by the fact that you don’t feel well. Your brain is again working overtime trying to heal. You inevitably will not remember everything. Somebody who knows you and your health history well is EXTREMELY valuable in filling in those interview holes.

Also, sometimes we don’t reveal the whole story for various reasons. If your loved one knows something valuable in helping to treat you, it should be communicated. Withholding information truly hurts the patient more than anyone.

You want someone there, looking out for you. As I stated above, the healthcare system has its flaws. It is not without error. Shoot — when I broke my hip a number of years ago and crutched in to my nursing unit to hand my nurse manager proof of fracture, she immediately sent me down to the emergency room to get it further investigated. (Whether or not that was out of true concern or disbelief that a 23 year old fractured her hip, one cannot say, but I have my suspicions). Once they triaged me and made me put on the awful green gown, I was taken for x-rays. 15 minutes later, a different employee attempted to take me for the SAME SET of x-rays.

Let’s avoid the # of times we shoot electromagnetic radiation to my pelvic region, shall we? You will be answering to mama if my fertility is affected.

Granted, this is a smaller example of a “near miss” in the medical world.  However, I provide it here to explain that they happen in all forms, to all individuals. No, nurses, doctors, therapists, etc. are not immune to it. Don’t worry healthcare friends, I am not about to break out the swiss cheese effect slides.

This point is of utter importance the older and more absent-minded (or crazier, whichever you prefer) we get. Knowing exactly what medications the patient is on is an absolute requirement to receive the appropriate care. I recently cared for an elderly patient who was being given 4 different blood pressure medications during her hospitalization. Her pressure plummeted and we didn’t know why… until her daughter revealed that she was actually only taking 2 of the 4 that were on her “current medication” list. Not good…and definitely not helpful for a speedy recovery and discharge.

Sidenote: There are helpful apps such as The Pill Monitor that help keep track of your current medications, dosage timing, full  list, etc.

Nobody knows you like your family and friends. If you start behaving in a concerning way, 9 times out of 10 — your loved one will recognize it before any staff member will. Simply because THEY KNOW YOU like none other. Someone being alert and in tune with your progression or decline for the duration of your hospitalization is only going to improve your outcome. Many a life have been saved by a patient’s family activating the Rapid Response Team in a timely manner.

You need the support. The hospital is not a fun place. We try to make you as comfortable as possible. The food has come a long way over the years (or not..depending on who you talk to). It’s still no fun to be there. You need the love of your people to heal. Consistent patient advocates are always preferred but shift work among family and friends is usually a requirement (what..you have lives?).

As a provider in the hospital — I personally see the direct effects of the above on a patient’s experience. Clear communication is the cornerstone here. It makes for a better, much better, outcome.

Stay well, friends.

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I Can’t Please Everybody

October 19, 2015

Sometimes I wonder if our grandparents felt the way we do in this generation. Does anyone ever feel like they have “gotten ahead”? — If so, please share your secret. Seriously.

My late maternal grandmother (God rest her soul), Bonnie, articulated our trending lifestyle dilemma so well: “Nobody has time for anything anymore”. What did she mean by that?

Time to make dinner?

Time to walk across the street and chat with the neighbor?

Time to open our bibles?

Time to play with our families outdoors?

As a woman, I feel I place a significant emphasis on attempting to multitask the various facets of my life. Be a good Christ-follower. Be a good wife. Be a good mother. Be a good daughter / sister / friend. Contribute to the household income. Contribute to the world. Take care of my patients. Keep the house (semi) reasonable. Do my best to keep up with family and friends.

I fall short. I fall short often.

The frustrations are palpable when I attempt specific mindfulness to appreciating a family member for something kind they have done, attempting to spend a few precious moments with a few precious individuals — all the while realizing I have inadvertently hurt another’s feelings all in the same evening.

Sometimes, I think so many of us feel we just can’t get ahead. Can’t win. Can’t get it all aligned. Our mental fatigue overwhelms our attentiveness and we don’t always foresee issues we could have avoided.

Thank God he has never expected that from us. He came, knowing every single one of us are sinners. He came knowing how badly we needed his love. He came to show us the way, the truth, the life is through him. (John 14:6). He knows we ALL have shortcomings.

Hurts. Disappointments. Tempers. Anger. Jealousy. Laziness. Greed. Guilt. Trespasses. Grudges. Pride.

He came to love us, knowing we are all sinners, and showed us the way to be forgiven for our sins.

So maybe tonight, and likely every day of my life, I didn’t please everyone. That will never happen.  However, the Lord gives me strength to start anew tomorrow, to know that his promises ring true forever. I don’t know him as well as I want to, but tonight feels like progress.

Better, much better. Not perfect by any means.. but better. Did I please everyone? No. Did I please him? I hope so.

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Why Are Nurses So Mean?

October 17, 2015

In the wake of the  The View commentary outrage, I curiously ventured over to Google to browse recent chatter about nursing. For those of you who do not recall or somehow did not hear by word of mouth, nurses across the country were quite distraught over the comments made about a Miss America contestant during her talent show segment.

The conversation went something like this:

Miss Colorado got on stage, in GASP, her scrubs.

Wearing a DOCTOR’S stethoscope.

…and to our horror, began talking about caring for a patient.

Within minutes, The View’s Facebook page was blasted with angry nurses, nursing assistants, nurse practitioners, nurse anesthetists, paramedics, physical therapists, physician assistants, and doctors (pardon me if I missed anyone — we appreciate the support!) commenting on the ignorance of their statements.

Movements such as “Show Me Your Stethoscope” (which is 781K strong and growing) erupted in titanic proportions on Facebook. Thousands of selfies with stethoscopes appeared. One ER physician posted a hilarious picture of at least 25 confiscated “doctor’s stethoscopes” from his RN colleagues. Another doctor wrote a detailed explanation about the importance of each RN involved in a surgical patient’s experience at the hospital.

…Which then caused the hosts of the show to somewhat forcefully apologize to all of those in the nursing profession the next day. Allegedly. Many did not take kindly to the gesture. I think because it was quite authentically not genuine. And I think the majority of the general population wonders:


What an intriguing question. What IS the big deal? Why are nurses so ANGRY? I have felt the anger myself many times over and it is extremely difficult to articulate at times.

Bingo. In my attempts to search for public answers to THAT question following this talk show calamity, Google revealed to me the top 5 questions the general public asks them every day about nurses.

The following image is a photo of the recommendations Google gave to me, based on popularity.

 why are nurses

Um…Ouch. Granted, people are more likely to search the internet for sympathy when upset with an experience. It’s like when we receive very poor customer service at the local auto repair shop, so we tell the world not to go there. It makes sense that searches for bad nursing would be more common than what actually happens with significantly more commonality every day:

A nurse takes amazing, attentive care of their patient, often saves their lives, and they go home safely. Nah. I’m not googling “Why was my nurse so amazing today?” — Why not? Because dude. Our brains default to the answer…because that’s their job? Plus, I’m busy breaking free of superbug zone and cruising in to the local Starbucks for a real java fix. Holler on the early discharge!

With further curiosity, tonight I have googled “Why are doctors…”

Any guesses?

why are doctors

Hmm. First of all, sorry to hear there is a trend of death among our MD friends. That’s not cool and I pray that has abated! Secondly, patients do comment, and comment often, about the attractiveness of their physician. I blame McDreamy. ..and the fact that MDs are sugar daddies / mamas.

However, there is much one can gather by these two different but very relative searches. It is apparent that the representation of nursing to our country is negative, which is beyond discouraging for so many reasons.

 The career of nursing is incredibly demanding and requires fierce resolve to pursue. We need to continue the conversation of reinstating respect for this profession and uplift our nurses that are doing such a dang good job.

Side note: Please think twice before asking your family member’s nurse for a beverage. They have many important responsibilities that fill their 12+ hour shift — that of which are increasingly being bogged down in documentation. Giving your nurse optimal time to provide bedside care will ensure the best outcome for the patient. I know a plethora of nurses that would gladly assist you with this request simply because they are kind, but please do not abuse that knowledge as an excuse to ask. Plus, it’s super healthy of you to walk downstairs to grab a drink, and provides family members with a much needed breather at times.

Hey, this is a small example of a nursing frustration. But, it is a start! 

Healthcare friends — thoughts?

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Why I am So Proud of People that Wear Their Lifevest

October 10, 2015

No, I’m not talking about the life vest we don when prepping to water ski, albeit we should wear that, too. The vest I speak of is manufactured by the company ZOLL LifeVest. It is a wearable cardiac defibrillator – medical jargon for a device that will shock your heart if it tries to stop. It is actually worn outside of the body, under the shirt. The LifeVest is prescribed by a doctor, nurse practitioner, or physician’s assistant temporarily to people with weak hearts.


Why you might ask? Because this product can actually save a life and has, many times. This happened just the other day, in our cardiac clinic waiting room. A patient was waiting to be called back into the exam room when suddenly, without warning, he became unconscious. Bystanders remarked that a voice was coming from his chest, warning that a shock event was about to occur. Like clockwork, his entire body was suddenly jolted. The staff yelled for the cardiologist, who sprinted to the waiting room and performed CPR (cardiopulmonary resuscitation) until the man regained consciousness.

Talk about being in the right place at the right time. 

What in the world just happened? Just 1 month prior, the patient was diagnosed with cardiomyopathy – meaning, a weak heart. When our hearts pump ≤35% of blood out of them with each beat (called the ejection fraction), we are statistically more likely to die from a sudden cardiac arrest. When he was first hospitalized, this man had an echocardiogram performed that revealed his heart was at risk for this. He was sent home from the hospital with a LifeVest.

This product is meant to be a temporary protection. There is a period of time – usually 90 days – that must be given to the heart to allow it to recover from whatever damaged it in the first place. Once the 90 days are up, an echocardiogram is repeated. If the heart continues to pump ≤35% of blood with each beat, it is recommended that a patient get a permanent, implantable cardiac defibrillator (ICD).

Many problems can cause a heart to become weak. The most common include:

The LifeVest was approved by the Federal Drug Administration in 2001 and now thousands of people wear them every day. It is a wonderful product, but anyone who has had to wear them constantly, 24/7, may tell you otherwise. I have heard many a complaint:

“It itches me.”

“It’s too restrictive.”

“It bothers my bra.”

“It’s not doing ANYTHING, why do I have to wear it all the time?

“I can’t sleep with it on.”

“I am allergic to it.”


I am a provider. I prescribe this product every week, but I don’t have to deal with the nuances of it every day. The truth of the matter is, most of the patients who must wear them for the usual 90 days will not have needed them…but there is always the one patient that did. We can never predict who it will be.

I watched the patient whose LifeVest shocked him walk out of the hospital this last weekend. He had a brand new, implanted defibrillator and was now forever protected from an unpredictable cardiac arrest. His wife was so happy he was coming home normal. She was also so happy she was able to wash the blue gel that is released from the LifeVest to conduct the electrical shock out of his shirt. Completely out. It’s the little things.

When I walked into his room to send him home, I had to remark like a proud mama “I am so proud of you for wearing your LifeVest.”

His response? “And to think about how I was getting so fed up with it, I almost stopped.”

Keep wearing, my brave cardiac patients. It is temporary, as all obstacles are.



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Why You Should Climb a Mountain

October 5, 2015

We are planning a trip to Asheville, NC to enjoy the foliage and Blue Ridge Parkway. MOUNTAINS. A term Floridians often are not able to incorporate into their vocabulary. It’s more like “Yesterday, I stepped on an ant hill”. In preparation for this adventure, I am reminded of the greatest hiking trip I’ve ever been on.

Mount Whitney

Mount Whitney

It started off as a solo venture. Dad, who has been bagging peaks (a hiker’s term for reaching the summit of mountains) while working as an engineer in Nevada, California, and Utah where the ranges are plentiful, announced to the family that he would next be climbing Mt Whitney. This mountain is the tallest peak in the continental US, measuring 14,497 feet, give or take a few. This was not your typical day hike.

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So close to our old Cali home – Ridgecrest

As his daughter and a concerned nurse, I quickly decided I wanted to crash the trip and hike it with him. Brent, my brother-in-law who loves a good adventure, was IN. Scotty, my little brother, would be working at dad’s mine in Moab, UT for the summer, so he agreed to be the fourth and final member of our ascent team (whether he actually wanted to or not remains to be determined).

I thought later about what this hike meant to me. Was I doing it strictly because I aspired to be my dad’s trail nurse, should the need arise? And what was it in him, or Brent, or my brother that drove them to do it? It was 22 miles round trip, a 6,100 foot ascent climb. Slightly different than the daily work out routine of stair-climbers. A quote from Edward Deci, who studied human motivation, helped me sort it out:

“Human beings have an inherent tendency to seek out novelty and challenges, to extend and exercise their capacities, to explore, and to learn.”

As I joked to my NP colleagues just the other day when attempting to put into words why our beloved, retired cardiologist friend retired 1 MONTH AFTER going live with electronic medical records (once of the worst headaches in this generation of healthcare) as opposed to PRIOR TO the roll out:

“When we stop learning, we stop living”. — We all chuckled because I sounded like a 75 year old grandma but it does ring true.

To climb Mount Whitney,  you do have to register for the hike lottery, as the trail only allows 100 day hikers per day. Our plan was to complete the summit and return back to the trail head at Whitney Portal by sundown, all in a days time. The experts averaged it would take us 12-15 hours if we got started by 4am. We set our trail date for June 27th, 2013, a Thursday, and were accepted as a group of 4 day hikers. Dad purchased 2 cans of heavy duty bear spray  and we made plans to meet in Vegas the Tuesday before.

From Vegas, we made the 4 hour drive to the small town of Lone Pine, California. We stopped by the visitors center where they handed over our day hike permit and 4 “pack out bags” or “wag bags”. It was a rule on the Mt Whitney trail to pack out your human waste…meaning if you have to go #2, you must perform the task in the bag and carry it in your pack for the remainder of the hike. We all aspired to avoid this unpleasant chore but we knew we were at the mercy of the mountain.

We went to the local Pizza Palace for our last full meal before the hike. After eating a fairly light meal of subs, we convened in dads hotel room while he safety briefed us on 3 important obstacles:

1. Footing
2. Altitude sickness
3. Bears

We then returned to our respective rooms to hit the hay by 7:30 PM because our alarms were set for 1:45 am. We wanted to get to Whitney Portal (the trailhead) by 3am to begin.
Waking up wasn’t terribly brutal, no doubt due to the adrenaline pumping through our bodies. We armed ourselves with hiking packs full of water, food, toilet paper, flashlights, wag bags, and picture phones, laced up our hiking boots, grabbed our trekking poles, and loaded up in dads lifted truck Sherman for a 30 minute drive to the trailhead.



We got there when it was still pitch black at 3:15 am and wasted no time getting started on the trail.  The start was exhilarating, we all felt full of energy. We crossed a few babbling brooks and streams, all the while remaining vigilant of the possibility of bear sightings. Every time we turned a corner, I almost tricked my night vision into believing an overhanging tree branch was a black bear reaching out to say hello. Dad said he noticed that I kept shining my flashlight (meant for footing) way out in front of him. The outline of the vast mountain in front of us was illuminated by the light of the moon. It was so peaceful to hike alongside.

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We hiked about 3 hours before we made our first official rest stop at sunrise. After an energy bar and a couple lengthy breaths, we were on our way again.

About 6 miles in, we reached Trail Camp, the place that sane hikers stop to camp out. According to a fellow trailer, we were “animals” for attempting completion in one day. Next up was the notorious 99 switchbacks in which you painstakingly crisscross up the mountain, gaining altitude every step of the way.


99 switchbacks to climb on the mountain, 99 switchbacks to climbbbbbb.

It was about this point (or sooner as we later confessed) that the early signs of altitude sickness set in. A very palpable headache, widespread and thump-like. Not pleasant. And with approximately 2.5-3 miles of elevation to go. We reached the Trail Crest sign, a noted marker that you are indeed making progress. We stopped to refuel and 2/4 of us (not to be named) used our pack-out bags. Hey, someone had to.

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The view from Trailcrest

The men

The men

Dad & daughter

Dad & daughter

The remainder of the hike up diverted to the other side of the mountain, which opened up into a vast and beautiful new view with deep blue lakes and ridgy, textured mountains that have been there for centuries. We were becoming exhausted and downright sick. At this point, it felt as if we were stopping every 5 minutes for one or all of us in the group to catch our breaths.

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God’s creation

I succumbed to the altitude sickness against a rock, making sure to turn away from the drop down cliff on my left as I relived the smell and taste of my peanut butter sandwich/cliff bar combo I ate a couple of hours prior to. My dad and I had a talk at that time (after he was very attentive with reassuring fatherly gestures…”oh sweetie, take some water”). He sat down next to me and contemplated for a few minutes. I knew what he was struggling with in his head. Do we continue? I was also building my defense case for absolute resolve to get up that stinkin’ mountain.

Our leader, dad, struck a deal: “Tell you what? If you do that again, we turn course and go back down the mountain.” We had approximately another 1.5 uphill miles to go. I said “fine”, felt much better anyway, and planned to remain stubborn with our uphill climb, double-vom or not. We had enough water to sustain ourselves. Another 0.5 miles up, Brent, my brother-in-law, sat down abruptly. We all halted for a breather. A few hikers began gaining on us from behind and we moved to allow them to pass. Exactly at that moment, Brent turns towards them and hurls big time.

“You gotta think of it as fertilizer, man” was the response he got, and off they went.
I secretly felt better the other sea level brethren had also succumbed to the same humbling effects of this massive mountain. We were comrads now.

We finally caught sight of our saving grace: the small hut that had been erected at the summit. It was in view. That last climb felt the most grueling and as we made it, the nausea won out again and I subsequently punished a big rock off to the side. By this point, it didn’t matter. No way were we turning around now.

When we made it to the hut, we found the trunk that sits against one of the walls. Hikers from all over the world have signed their name and date of completion, which later becomes part of our national archives, so we are told. We made our mark on the cardboard of the last notepad available. Brent placed an Orange Park fire station sticker in the chest.

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As we took a seat on the flag rocks of the summit, a fellow hiker emerged from a different pathway up called the John Muir trail. His friend, who was already there, asked “How was it?” The hiker’s disgruntled response:

“If John Muir was here, I would head
butt the sh*t out of him.”

Dad did his best to make us refuel but there is a sensation of being at almost 15,000 ft that makes food as appetizing as the wag bags still in our backpacks.

We recovered as much oxygen as possible, scanned the 360 degrees view of the beautiful Sierra Nevada mountains, and stood back up to begin our descent. Before leaving, dad pulled out a picture of our late uncle Gerry Cummings, a marine with many years of service to the country of America. “This is a place of honor”, dad said, “it makes sense that Gerry is here”. We all held his photograph and took a picture to commemorate that moment.

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Being on top of that mountain, surrounded by God’s beautiful work, made me feel closer to him.

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Boy, we felt on top of the world — and in a literal sense, we almost were. There was just the small feat remaining of walking back down the mountain. That’s all. For anyone contemplating this hike, I can tell you the altitude sickness is completely self-limiting. As our altitude footage decreased, so did our nausea levels. It was grueling and mentally deflating — we had worked so hard to get to the top and now we just have to walk down for 11 miles? LAME. We began to fantasize about our dinner. Undoubtedly, it would be back at the pizza joint because Lone Pine has approximately 1.5 restaurants within a 30 mile radius. We were each going to order a full pizza and beer. Oh yeah.

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The start/finish of the trail

We finally made it to the end of the trail and met some really nice hippies there. They applauded us for finishing and I think I might have cried. Dad’s knees were on fire. Brent was so hungry, he was bear hunting. Scotty’s anger at the turn of every corner revealing MORE trail subsided. The sheer joy of completing the mission we set out to do was beautifully satisfying in every way. Our faith was put to the test as we were challenged mentally, physically, and spiritually. I categorized that day as one of the best in my life — for reasons I can’t fully explain in writing. I think my trail family would agree.

It was like you felt  yourself grow.

Would I recommend this trail? Absolutely. Do you have to be a little crazy to complete it in one day? Yes. So, think about going to climb a mountain. Have the faith. And if you do, PLEASE tell me about it. We came out of the experience better, much better.

faith to move mountains

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Today, I Got Nothing Done

September 24, 2015

It was one of those days I started out with a mission in mind: GET. STUFF. DONE.

I had a list of mental to-dos that had been transcribed to my smart phone’s notepad application that I was determined to check off, one by one, so as to document my efficiency to the world. “See what I did?” It was a special Wednesday for me too, because I have been at the hospital rather consistently lately, seeing patients. The home work was lacking, backed up, screaming for attention.

We (Adam) had finally conquered the main living quarters circa 1985 wallpaper. It came down, shred by shred. To those of you who state your wallpaper came down in one swift sheet:

A) I don’t believe you.

2) Prove it.

Our plan was to maybe sand off the remaining pieces and visit our local paint shop to browse color choices for our newly naked walls. The heaping piles of laundry in each room’s respective baskets were going to be tackled. The cardiology article I am to write for a looming deadline was going to elongate. Ah, it was going to be a productive day.

My 9 month old had other plans. The poor kiddo started to “vom” (a West coast term for throw up that I recently picked up) consistently and unpredictably. His first GI bug and it was so sad! Mommy hasn’t had to experience her baby looking at her so sadly with a “help me” face before getting sick repeatedly. It was also extremely time consuming. Without fail, whenever we would step foot off of an easy clean surface (such as tile) onto a super absorbent flooring (think: carpet), the VOM came ON. Lord, give me strength.

Isn’t that when we seem to talk to God the most? Out loud, looking up, trying to make sure he hears us? He is so present, knowing that we are reminded how much we need him in our most difficult moments. Mind you, I understand my kid being sick is no where near many’s darkest days but when you are “in it”, in the midst of all of it, it sure feels like a moment of despair. Everyone has their own moments of hopelessness, and new mommies and daddies are amongst them.

It’s ok… and so part of life, to feel this. Shoot, there is even a song dedicated to it:

“My momma told me.. there’d be days like this.”

Van Morrison reportedly wrote these lyrics to remind himself on those really good days where you feel like you’re winning at life — that you should stay prepared to have those more challenging ones that knock you down a peg or two. Some of us have more of them than others — sometimes WAY too many in a row. I don’t think anyone but God knows the answer to why. I do know that the most inspirational people I have met have been through some humdingers. They have dealt with many a trial and tribulation and have emerged better, stronger, more courageous. That gives us hope on the hopeless days.

 So, today I comforted my sick child and my pessimist side would say “I got nothing done”. But I know God and he tells us:

 “More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope” Romans 5 3-4

My day pales in comparison to the daily struggle that many of my friends and readers battle, this I know. However, I firmly believe in allowing us all to express our feelings out loud, to each other, because only then can we grow in our faith together. My neighborhood church group has been wonderful for this. It’s a safe space — and no, that’s not scary church talk for holding hands and humming — but it means we can all share in each other’s victories and failures the way God intended. I’m glad the day ended with them. Truth be told, it was the last thing I wanted to do. Get dressed, leave the house, socialize.

When we first made the decision to attend a bible study group, I was TERRIFIED. What if they make me hold my hands up, talk to God in front of them? Do I know any scripture verses by heart that I can recite to sound like a worthy Christian? What if someone judges me because I let it slip that I drink wine and beer? These were some of the thoughts that ran through my head while walking up to the door of our first neighborhood meeting. I am so glad these “church people” proved me wrong. They just love Jesus. And they sin, like me. I can’t stress enough how much this group has helped me to grow. I didn’t realize I was missing such an important part of life and fellowship until we had them.

If you live in the area and are interested in hanging out with some awesome people, I’ll get you in touch with a great church or neighborhood group. Ours is always actively recruiting!

If you want to talk about this matter further privately, please be in touch.

Tonight, I’m feeling better… much better. (Our son is, too btw)

sawyer sick day

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6 Questions to Ask the Provider Who Wants to Prescribe You a Medication

September 15, 2015

Medication prescriptions account for a massive chunk of healthcare expenditures every year. Reportedly, Americans shell out $52 billion per year in drug costs alone. It is a booming market and one that some say is growing out of control. Concern regarding over-prescribing is a question of hot debate in medical circles, and rightfully so. Listed below are 6 key questions to come armed with at your next healthcare provider visit before you leave with script in hand –who am I kidding –more than likely, before it is e-scripted to your pharmacy.

This is me, with my prescribing pen. Buyer, beware.

This is me, with my prescribing pen. Buyer, beware.

1. What is it for ?

I can’t tell you the number of patients I see on a daily basis who have NO IDEA what they are on or why. What a scary thought. Agreeing to take a pill once, twice, even three times a day is a huge commitment. Not to mention, learning to be wary of possible interactions it may have with other necessary medications. Most importantly, you need to understand what exactly this medication is supposed to do and continue to reevaluate if it is assisting to keep you healthier. If it’s not, GET RID OF IT, with your healthcare provider’s consultation and instruction, of course.

2. Are there any alternatives to taking a pill?

Nine times out of 10, yes. Some of the most commonly prescribed medications in America are antihypertensives (medications to treat high blood pressure) and cholesterol-lowering medications (medications ending in “ –statin” mostly commonly). In certain populations, it is extremely important to utilize these agents to achieve effective control of blood pressure and cholesterol levels. Think someone with a previous stroke or heart attack – they fit the mold.

However, a 35 year old man who goes to the doctor for a routine check-up or specific complaint may find himself walking out with a prescription for a blood pressure medication simply because he had white coat hypertension – a condition where your BP rises just at the sight of a provider in a lab coat.

Most of us don’t want to hear this but YES, there are true alternatives to drugs. Such as diet and exercise and getting enough sleep. Personal accountability is crucial and necessary when trying to avoid meds.

3. What are the main side effects / concerns with this med?

This causes your provider to delve into their mental piggy bank of experience. I am willing to bet they have put multiple patients before you on this medication and have received tons of useful feedback.

“It EXHAUSTED me..and it didn’t get better.”
“It makes me so nauseous, I can’t handle it.”
“I woke up in my apartment building elevator wearing only my underwear and a sombrero.”

Ok..the last one may be extreme, but you get the picture. Providers have valuable knowledge about the adverse effects of the medication and know what to look out for. Does it run a risk to your kidneys long term? Liver? Medications are excreted through these very important body systems, so it is extremely wise to know what the potential long term effects are of anything you are putting into your body. Sadly, some medications prescribed with the intent to help do the polar opposite and worsen how you feel. What a bummer.

4. Do you anticipate me being on it for the rest of my life?

HUGE question. A lot of patients tell me they had no idea they were signing up for lifelong therapy. Some medications are used short term or on an “as needed” basis, such as antibiotics or inhalers. Even some heavy duty medications such as antiarrhythmics or blood thinners are used short term in some instances. However, many are prescribed with the intent to CONTINUE them indefinitely. It may be just me, but this is something I will want to know about as a patient.

5. How much will it cost me?

Another biggie. As a healthcare provider, I fully admit I do not know the cost of every drug I prescribe (cue: throwing tomatoes) but it is very difficult to! The cost varies with each insurance carrier and there are a plethora of medications available. We get our best information from, you guessed it, our patients. If your provider wants to put you on a medication that initially will only cost you $10 / month with a co-pay card, it may sound reasonable. However, this can quickly change after the honeymoon deal comes to a screeching halt between your insurance carrier and the pharmaceutical company. Do your homework.

6. Why do you want to put me on it?

Ah, the meat and potatoes. This forces us to EXPLAIN our rationale and gives you, as the patient, much insight. Are we concerned that you have an infection? That you may have a stroke? Do we really think the benefits outweigh the risks of this medication? I wholeheartedly believe that the majority of providers only want what is best for our patients and our practice should reflect that. If your provider cannot answer this question, find a different one that is willing to.

The point of this article is not to label medications as bad or unnecessary. Truly, it cannot be argued that many a life has been saved, improved, or prolonged by the appropriate use of medications. As healthcare continues to advance, our tool box of available medications will only grow. We have a fantastic opportunity as patients and providers to collaborate as a team on the best course of action. Remember: you are the #1 player in this decision and your contributions to the conversation only make the outcome better…much better.

 I have added an e-mail subscription option at the very bottom of the page if you want to be updated on my latest posts. If you know someone that you think this article will help, please share it with them!

Click on the title link to comment – I would love to hear your thoughts as providers, nurses, and most importantly, AS PATIENTS.

P.s. I picked orange as a color flair because its nearly fall and pumpkins are my favorite. In no way should it be misconstrued as a nod to the Gators ;). 

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5 Secrets of a Top Notch Nursing Student

September 3, 2015
Circa 2007 - FSU College of Nursing Class of 2008

Circa 2007 – FSU College of Nursing Class of 2008

Public service announcement: It is clinical start up week in the nursing school world. For my nursing / MD / medical assistant buddies, you are well aware. You sniffed out the starched, white, front-zipped uniforms from 2 telemetry units away. The staff on the floor has suddenly doubled, seating room has become a luxury, and you have never seen so many nervous eyeballs in one room.

 Nurses have caught a bad rap in the past for “eating our young”. At times, we have been labeled demanding, impatient, unwilling to teach. Admittedly, this is often true. Below, I will attempt to assist the poor soul of a nursing student that we all once were with some super helpful tips to create a lasting impression and get you through the day with success. As a nurse practitioner, I have personally observed these behaviors in the students that stand out to me.

1. Look up and smile when someone is approaching you. This is true for your assigned RN for the day, even if you got the “grumpy one”. It also applies to a difficult family member, the medical assistants, the ARNP/PA/MD drilling you with questions you don’t know, administrative staff, etc. A smile is the beginning of an offer of a pleasant exchange. It also ACKNOWLEDGES a human’s presence — something I think we all appreciate. It also implies that you are there to learn and absorb.

2. Always have your stethoscope and scissors. My Labor and Delivery RN mom taught me this one (at least the scissors part — I have a cardiac background so the stethoscope is a pet peeve of mine). One would hope you are using your “ears” on a daily basis and even if you do not find yourself utilizing the scissors, undoubtedly SOMEBODY will need them. You will then wisp in as the prepared superhero student. “Here they come to save the dayyyyyyy!!”

3. Do not take it personally when your nurse makes it clear they do not want a student. Consider it one of your first of many mental toughness lessons and make the most of it. I will clue you in as to the reason: it is well known in the nursing world that taking on a student requires an increase in energy expenditure. Some react poorly to this realization. (God bless those that take it in stride and you under their wing, right?) The best advice I can give you is to PROVE THEM WRONG. Be as helpful as possible. Be as nice as helpful. Be annoyingly cheerful. Memorize this mantra: I can survive anything until post-conference.

4. Avoid laziness. I have to tell you, nothing is more frustrating to a nurse than to see a lackadaisical student absentmindedly flipping through a chart or twirling their hair. Not like you can do the latter, with how tightly school requires you to bun up these days. Don’t they understand traction alopecia is REAL?! We are also compelled to notify you that if you are beginning a N-U-R-S-I-N-G career with no pep in your step… well, good luck and good riddance. Statistically (or really just my opinion), you won’t last long.

5. Be sure you are purposefully asking to DO things. No, that doesn’t mean you can push narcotic medication or attempt to insert a central line (if this sentence confused you, please refer to your nursing school’s clinical policies and procedure handbook immediately). It means take advantage of every opportunity, particularly during downtime. Help the medical assistant make the bed. Go with the case manager to discuss discharge plans. Take the initiative to learn as many facets of the healthcare system as possible while you have the chance. Trust me, come orientation time at your first nursing job, there will be plenty to learn alone in that role. Yes, I understand that darn care plan assignment is 75% of your grade but digging through the same paperwork 3 x over doesn’t help a thing. You learn more by experience.

Yes, there are many other elements not touched on above that contribute to the development of a stellar nurse. We can certainly discuss those later. However, I highly recommend kicking off this clinical season with the above insights. You will be sure to impress your clinical instructor and assigned nurse — and certainly me — as I will be on the look out for you. Please smile and oh, by the way, may I borrow your scissors?

Stay better! Much better.

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Jealous of a Good Nurse

September 1, 2015

Where did that statement come from… “..always wanting what we don’t have..”? Is it purely human nature to constantly assess our surroundings and think to ourselves there MUST be something more out there? Something different. Something better than where I am now? In one sense, it is productive. It makes us strive for continual self improvement. On the other hand, it can leave us with a plaguing feeling of discontent. I recently had a discussion with my husband about if I missed nursing. It left me wistful — which honestly, shocked me because I couldn’t wait to “move on”. 

nurse graduation outfit

Look at this bubbly nursing graduate.

As a bedside nurse for 5 years, there wasn’t a day that passed that I thought “How much longer can I do this?” It is insanely taxing work. The hardest job I have ever had. I was reminded of that while reading this Huffington Post article written by a hard core ICU RN. She points out the raw emotion and dire circumstances that nurses confront every day. Physically, a nurse’s body is put to an endurance test for 12+ hours (who are we kidding, at least 13) at a time — actually requiring recovery time during that next “day off” that other careers are so envious of.

Mentally, it is just as exhausting. It would be a gift from God if nurses were able to focus solely on a patient’s individual circumstances. That is just not the case anymore. The old nursing textbooks would recommend giving your patient a back rub if time permitted. Now, any extra smidgen of time is dedicated to catching up charting that is forever behind, checking the appropriate boxes on patient rounding policy forms, or completing endless computer competency courses about how to create incident reports.

Spiritually, you are tested to the brink. Don’t get too attached to that old man with metastatic prostate cancer who is trying desperately to get home to his wife with Alzheimer’s disease because she needs him and he’s the only one that can keep her calm. You can do everything possible to relieve his anxiety and symptoms, but you can’t cure his disease or her brain. Don’t take it personally when your homeless patient throws his IV at your face. He doesn’t have a place to go when you discharge him, so it’s reasonable that you should be punished with projectile bodily fluids. Take a deep breath when your nurse manager tells you to call security to further deal with getting him out, because you have a code blue coming from another floor that needs immediate, intense care. Avoid slapping the environmental safety squad as they shake their finger at your CLOSED water bottle at your nurses station. Because you always have plenty of time to walk down the hall, to the break room, to grab a sip of water. Not.

{Side bar: One of the reasons you hear a nurse say they weren’t able to pee all day was because they were flirting with acute kidney failure from dehydration}

You barely have time to feel a human emotion — before the demands of the profession require a complete shift in attention to another disaster. You’ve got to be tough. And boy, you have to be willing with a good heart. A good nurse is a Godsend. You better believe it. Treat your nurses well.

My last day at my first nursing job.

The last day at my first nursing job.

I hope that I was acceptable at the bedside and that patients benefited from me being their nurse. There never was a day when I didn’t feel like I did something good for mankind. I’m also very happy with my current role as a nurse practitioner. It is an extremely important part of the healthcare team, we are challenged continuously, and I believe we make decisions everyday that impact a patient’s care for the better.

Still, I would be remiss if I didn’t admit that sometimes, I am envious. Seeing the direct effects of your own nursing care and judgement at the end of the day is a deeply satisfying outcome of a job well done. The relationships and trust formed with your patients in their most vulnerable moments cannot be replaced. These days, as I walk into a nursing unit or floor and spot one of those really good RNs that one prays is assigned to them when their time comes, it fills me with gratitude for my healthcare friends that remain steadfast in their pursuit of the nursing career. You guys are my HEROES! (That includes you, mom).

mom on my wedding day

First and foremost, we are nurses.

listening to my heart

Nursing friends: I want to hear from you! Are the above words true?

What is your relationship with nurse practitioners?

Are we still considered nurses or not?

Click on the title link to comment: I promise, no backlash 😉

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