I am a new PICU nurse.

I am a new nurse in the PICU, and that means that my schedule often leaves me wondering what day it is, what time it is, and what to call the meal I'm eating. It's very disorienting coming home in the dark morning and seeing people fresh from showers getting into their cars for work or to see kids waiting for the school bus. It feels like night, and I am ready for bed, but it is really morning. Do you say, "Goodnight," before you go to bed at 8:30am?

I am a nurse, so I pretend to be confident, to have things together. But sometimes I feel as though I am walking in circles. Sometimes I really am. Parking... There are several parking garages, several randomly closed streets, and a mountain of traffic. Navigating... After I park in the correct parking garage and find the correct exit, there are several tunnels connecting buildings. I must find my unit in a matrix of unmarked hallways and dungeonous-looking corridors. I function mostly by intuition, and this makes navigation hard. Once I come to a fork in the path, I first try the hallway that just "looks right" or "feels right". One of my classmates recently decided that she should invent a GPS for inside buildings. I have sarcastic feelings about that. Things like, "Then we can really rely on technology instead of our brains." and "Then nobody ever has to know where they're going just like we never know people's telephone numbers." and "I think they already did that. It's called a map." Stuff like that. But the other part of me is honest with myself and thinks it's brilliant. Storing my lunch... I must say that this is a relatively easy task, and I think that I can confidently say that I have mastered it. Finding a bathroom... Very few toilets service all of our nurses and visitors. It's incredible, really.

I am a rookie, and that means that I make everyone else feel smarter. There are new orientees coming through every three months. So right now, we're the rookies, but in a month, we won't be. The rookies who just graduated from rookieship helped me fill out a piece of paper the other day. Then they looked at each other and started laughing, because somebody is finally dumber than they are. It's a good feeling.

I am a new nurse in the PICU, and that means that I am in shock. In nursing school, our patients were mostly alive. Usually, we could have conversations with them, take them for a walk, ask them about meals. Now, my patients are mostly dead. I might've already said this, but I used to think sick meant throwing up, pooping your guts out, etc. Now I realize that "sick" can mean unresponsive, deformed, brain dead. When I first got here, I wanted to wander around the unit in spare moments and see what else was going on. Right now, I am having trouble. When I walk around, I hate what I see. It catches me off guard and I am pricked at the unnatural body positions, unnatural facial expressions, unnatural portion of death among the living. Sometimes I come home, and I just lay on top of my husband and cry.

"Are you wiping your snot on my shirt?"

"Yes."

"Man, now I have to change shirts this week."

He says other things, too, that help me breathe and function. Simple things like, "Why does it have to be your goal for them to get better?" And it's profound, because some of them are not getting better and are not ever going to get better. If my goal is for them to get better, I fail. If I can change my goal to just love the poor, suddenly, my work is meaningful. Suddenly, I am doing something that matters deeply to my Savior. "Jesus said you'll always have the poor."

I am a new PICU nurse, and it means I'm functioning. It means I'm wondering if nursing is really the right career for me. It means I'm crying more than usual. It means I'm tired. It means I'm leaning on my people even more than usual. It means I'm hearing beeping in my sleep. It means I'm learning to take care of the sickest kids in the hospital. It means something, and that means everything.

Till we have faces, I don't see.

I went to church on Sunday, and it was a long awaited relief. This East Coast thing is very...different. I have not met my neighbors even though I've got two doors six inches from mine. I don't really expect to know their names unless I get really ambitious and introduce myself. Anonymity is the norm.

The people at church were warm, but not fake. We sat by an oncology nurse practitioner who began her career at my facility. Her husband is a techie and musician. They and their children are hoping to be missionaries in the Middle East by the end of the year. They invited us for bagels with their family after church. They've adopted a kid from Guatamala and have three of their own. They also invited us into their small group. I'm itching to be a part of it.

Anyway, church. The pastor's laying the groundwork for a series related to life's big question: Why? He's speaking about the question with words that relay that he's asked the question before like the rest of us. Simple words weren't enough for him either. He needed more like the rest of us.

It's a tough thing for a pastor to address. It would be so much easier to preach a sermon on prosperity or to get people all hyped up about God being alive and everything else. But he's taken it down a notch and pricked every heart. He's treading carefully, thoughtfully.

He advises us all to draw a closed shape like a circle or a square. It represents God's wisdom and knowledge. He asks us to shade in our portion of wisdom and knowledge. "Do you have a dot on your paper? Can you even see it? Maybe some of the answers to the why's lie within God's wisdom and outside yours."

I'm glad it's not the end of the series; it would be a real bummer. But it lays the groundwork. Why deformed bodies? Why beatings? Why brain death? Why trauma? We wouldn't be asking if we understood. But perhaps there is an answer. Maybe we don't have access to it.

Haven't you heard so many people say, "When I get to heaven, I'm going to ask..."? I stole this idea from this sermon. It was stolen for the sermon from some writer (CS Lewis?). Maybe when we get there, our knowledge and wisdom will brighten and all we'll say is, "Oh, I see."

"Now we see through a glass dimly, but then, face to face." It's my hope, and I'm hanging on.

Nice About Death Flavor

There's this really cool girl in orientation with me. She's been a PICU nurse for a long time and traveling as one. Traveling nurses sign short-term contracts with hospitals who are short for nurses. They are thrown into the mix on hospital floors with very little orientation. They need to be adaptable and competent in their work. It is well-known in the profession that it is a very high-paying position. Hospitals go to travelers as a last option. It costs hospital units a large portion of their budgets. Most units would prefer to spend that money making new hires, but at times, there are none immediately available. When there are patients, hospitals must have nurses, so traveling agencies are services committed to filling those positions.

It's a general theme right now around the country that traveling nurses are landing regular staff RN positions at hospitals, because of the economy. They want stable positions, because the window of opportunity for getting staff RN positions has been closing. This girl has a rich background of experience in the PICU, and she's going to be working in my hospital as a PACU nurse. Pediatric Post-Anesthesia Care Unit. She takes care of kids in the transition between the completion of surgery and their transport to hospital beds. She keeps kids from dying as they wake up from surgery. She also reminds me of Meg Ryan, but looks more like Claire Danes. So I stare at her a lot. I hope she doesn't notice.

Anyway, she told me that people will come to me, because I am nice about death. Then our leader chimed in. "She has an oncology point-of-view." She says oncology and the PICU clash in their thinking. I guess PICU nurses are generally not welcoming to death. They generally do everything they can to stop it, even after it stops making sense. It's their job. It's the parents' wish. It's the doctor's order. For whatever reason, it's how they function psychologically. To switch the goal of care from "get better" to "die well" would be, according to our nurse educator, "too much" for the PICU nurse. I don't think that's true, though. But I have no experience to back it up. I think there are points where even PICU nurses want to tell the parents to give up. Anyway, my facilitator suggested that there should be a palliative care unit where patients can go after pulling the plug - a unit the specializes in helping patients die well, a unit separate from ICU nurses.

It's going to be different. In my last nursing experience, we were helping people die all of the time. It's a healthy thing to die well, to be allowed to talk about it, to be allowed to grieve it - even before it comes. That's how I see it. Death is a good part of life. But I would see it that way, because I come from oncology.

It all goes into the mix. Everybody brings their specific flavor to the team. There's a girl who wanted to be a vet and worked with tigers and dolphins and whales for a while. Another girl went to Bethel at Minnesota and prays before she eats. Meg Ryan brings her flavor. Us new grads bring our flavors. It's going to be a tasty treat.

Dream Theme

Last night, I had a dream about my childhood friends. I was at Michael Vandal's lake cabin with my friends Katelyn, Adam and Marla. We were doing lakey things like skiing and swimming and what-not. Katelyn was going to take me skiing, so she was setting up the boat. It was going to be the last ski of the season which is usually really warm, but for some reason, this time, it was really cold. Suddenly, the lake started flooding several inches a minute. The boat Katelyn was preparing tipped over! There was no choice but to start a rescue mission for her. The lake had two life-yachts tucked away around the lake, and one of the locations of the boats was Michael's cabin! So I navigated the boat a little. I picked up these two old ladies who were hanging out in the water in lounge chair floaties. The last thing I remember was thinking, "I should probably pick up some people who will be useful to me on this mission."

It's the strangest thing, though. I have had several dreams where Michael Vandal is a major part of the dream since graduating from high school. No big deal, right, but the kicker is that we were never really close friends. I dream about him more than any of my other classmates, except for Katelyn with whom I am still very close.

I don't remember having a huge crush on him or thinking about him a lot. We talked once in a while, but not any more than any of my other classmates. I have one significant memory of him from high school, but it's not anything that special. I had decided to quit basketball, and it was a major decision for me. We had a serious conversation about that. I don't even remember what we said. He might've said, "I think you're making a mistake." I might've tried to explain my decision. He might've listened. Normal stuff. It was significant to me, because I was having a really hard time with that decision. Somehow, he helped me a little bit...I think.

They're not racy dreams, either. Normal, everyday stuff. I had one once that we were sort of flirting and I wanted to show off for him. We took a bike ride, and I rode my bike right off of a cliff. I remember falling into the abyss and thinking, "Well, that was a dumb move." In another one, I was swimming in the ocean, and there was this polar bear that was swimming with me, and then a big boat came by, and I think he was on the boat with Jenna Milbrath.

But this morning, I was thinking about Michael Vandal - really analyzing why he would be in so many dreams. I think he might have been the very first boy I ever liked. I forgot about it, though, because it was in kindergarten. I remember saying stuff like, "I love you so much, I'm going to kiss you!" And then I did on the top of his head. He had a buzz cut and I liked that. I still like that, actually. I remember the kindergarten thing to do was to tell each other how much we loved each other with our hands, sort of like our love was a fish we just caught. "I love you thiiiiiiis much." And I remember that I told Michael that I loved him so much that the backs of my hands were touching behind me...which I totally can't do now. I wonder if that's a warped memory.

Now that I think further, I think he was the first boy that ever told me he liked me, and then said he hated me. I don't remember what happened, but I do have that vague memory. So maybe he's been stuck in my dream world, because early on, he was set in my subconscious maze as some sort of symbolic pillar. That must be it. Right?

A New Job

I've just begun orientation for a position as an RN in the pediatric intensive care unit for an inner city hospital. It's funny; I still feel a strange sense of loyalty for my old workplace. I suppose it's natural for outstanding facilities to leave a lasting impression. It doesn't matter, though. The real loyalty will be for my patients, no matter what roof is over my head. Truly, either hospital makes a great roof.

Hospital orientations are usually set up quite similarly. First, you go through a period of general hospital orientation. This part of orientation is gruelingly boring. At one point, I figured that my head bobbing up and down trying to fight my lids was probably drawing more attention away from the speaker than if I just rested my head on my hand and let my lids do their thing. I'm a few bucks richer for having gotten through it alive.

We've moved through hospital orientation and general nursing orientation. We're on to departmental orientation: pediatrics. I haven't gotten to taste the buffet I came for yet, but I'm a step closer to the nitty gritty. Today, I met with the peds nurse educator and all of the nurses that are starting new positions within the peds department. Interesting things were said today, things about magnet status, about professionalism, collegiality with doctors and other healthcare staff, education. This kind of language is making me feel comfortable again, like I really am in the right place. Each nurse in the room told how we became nurses. Only one of ten desired to be a nurse from childhood. The rest of us happened upon it, you could say, and didn't really understand what nursing was about until we found ourselves to be one. "Nurses are the only ones who really know what nurses do."

In a few days, I'll start my specialty orientation: PICU. I'll be in orientation a total of 16 weeks. When I'm through, the goal is to be competent to care for two stable patients on my own.

Nowadays, I'm feeling patient with myself. I'm not pretending to know anything, not even to myself. It's all new, and there's a certain period of time where it's okay for everything to be new. It's okay to be able to be picked out as the newbie. I'm the one wandering around the building with my mouth open looking to the ceiling for answers. I figure it enriches everybody to have a newbie around. I'll take one for the team. Inner city life, commuting life, where to park, which place not to stop in the cafeteria, whose faces and names to remember...not to mention policies and protocols, IV infusions, and expanding my knowledge of peds anatomy and pathology. It's a new job. It's the name of the game.

"There are three kinds of people in this world: those who watch things happen, those who make things happen, and those who wonder what happened." -lady in orientation.

Marriage of the Lamb

I wrote this song to be sung at my wedding. Besides being married at the end of the day, I wanted very much to bless those that came with the idea that this ceremony is just a foreshadow. One day, we'll be dressed in clean garments and be presented to our bridegroom. Check out Revelation 19-22 for the full effect. It's intense.

Marriage of the Lamb

Behold, the bride has been made ready.
She wears the white dress of the saints.
She has been waiting just to see him.
She'll be with him today, the start of forever.

Behold the groom has come back for his bride.
His face was hidden for a time.
Now he has come to wipe her tears away.
He'll be with her today, the start of forever.

Behold the marriage of the Lamb.
Behold His covenant is strong.
He’s come to save his bride from darkness.
They'll join as one today, the start of forever.

Bloody Affair

Church was amazing this morning. The normal pastor is on a sabbatical for two months, so a man from within the church spoke on atonement.

He took us through the whole Bible, from Genesis to Revelation, telling us of animal sacrifices, and finally, the ultimate sacrifice. Adam and Eve reaped the benefits of the first sacrifice. They sinned and suddenly knew that they were naked. God provided clothes for them of an animal's skin, the very first shedding of blood that atoned for the sin that opened their eyes to their nakedness.

A few chapters later, God provided a substitute for another man. Abraham was willing to offer up Isaac, but did he know God would provide a substitute for him (Gen 22:4-8)? He provided a substitute in the same city, on the same hill on which He would later provide a lasting substitute for sin.

One of a few more stops in the Old Testament tells us of Noah making sacrifices for the spared lives of him and his party as soon as the boat came up on shore. In Exodus, the children of Israel used the blood of a male, unblemished lamb as a sign to escape death. "When I see the blood, I will pass over you." Job made animal sacrifices for the sins of his children just in case they had.

Blood makes us cringe, and it's for good reason. Leviticus says the life is in the blood. A friend of mine once told me, as a nurse, "When you see blood coming out of your patient, you recognize that their life is going out from them. You stop that blood in any way that you can." Just so, the animal's life was going out, and God made it clear that the Israelites were to witness it. They were to experience the horror. Their sins, according to justice, required life, the animal's life for theirs.

Isaiah wrote of the same blood in chapter 53, but a different type of sacrifice. This sacrifice was God's firstborn, and after his sacrifice, no other atonement would need to be made.

Romans 3:25-26 "God presented him as a sacrifice of atonement, through faith in his blood. He did this to demonstrate his justice, because in his forbearance he had left the sins committed beforehand unpunished— he did it to demonstrate his justice at the present time, so as to be just and the one who justifies those who have faith in Jesus." The entire New Testament is based on the atonement that Jesus made for sin once for all.

Finally, in Revelation, we see that we'll wash our robes so we can take part in the Marriage Supper of the Lamb. What will we wash our robes in? "...washed in the blood of the lamb..."

The story of atonement is found throughout the entire Bible, and it's a bloody affair. It's part of what makes it grip us. It's part of why it changes our whole lives when it does.