Friday, September 23, 2016

Real Women

I've had something on my mind: Real Women.

Look around you sometime at the grocery store, or gas station, at work or at the gym.  Look at the real women around you.  How many of them look like the women on cover of magazines, in commercials or at elite fitness competitions?  I propose almost none.  There was one woman today who I saw at the gym who legitimately looked like a elite fitness/pin-up model.  Maybe she was one.

Our sex-crazed culture is so perverted in it's message about what a woman should look like.  Most of us real women spend way too much time, money, thought and energy into trying to achieve some semblance of that air-brushed, artificially-preserved image.  To clarify, my point here isn't let yourself go, throw healthy diet and exercise out with the dirty bathwater of trying to look like the perky-disproportionately-large busted, thin-waisted, flawless-skinned, whitened teeth, stylish, muscle-up repping, 7% body fat, tanned-skin woman we are being told everywhere is what a beautiful woman should look like.  The thing I want to say here is real women everywhere who care about a healthy diet and who exercise their bodies to keep them healthy are all shapes and sizes and have varicose veins, hemorrhoids, postpartum depression, premenstrual syndrome, endometriosis, migraine headaches, fatigue, acne, heavy periods, irregular periods, infertility, eczema, psoriasis, wrinkles, freckles, moles, birth marks, scars, cow-licks, curly hair, straight hair, thinning hair, no hair, brown eyes, blue eyes, blind eyes, glaucoma damaged eyes, are near-sighted, far-sighted, lactose intolerant, have Crohn's disease, osteoarthritis, cancer, hypothyroidism, hyperthyroidism, auto-immune diseases, amputations, skin-grafts, transplants, hearing loss, joint-damage, injuries... I could go on and on.  My point is, none of those things that real, beautiful women live with every day show up on that cover of Fitness Today, or in the friggin' Carl's Jr. commercial with the seductive woman nearly orgasmic over a hamburger for goodness sake!

I have the privilege of talking to lots of women.  Most of them in the hospital for some malady that has plagued their lives or some injury or trauma that has drastically changed it forever.  Their ages range from teens to 100's.  Some of them are strikingly beautiful-  if you saw them all cleaned up and made up and in their best clothes and their best health in the best light you'd be like, "Whoa!  She's beautiful!"  Most of them though wouldn't probably catch your attention on the physical beauty radar, but that's just the thing.  That's MOST of the women in the world.  There are stunningly beautiful women, no doubt.  But most of us are in the girl-next-door beauty category.  We might have beautiful eyes, but our jaw line is receding, or our nose is crooked, or we have an acne problem or we're pear-shaped... and supposedly those things make us not very beautiful anymore according to the media message we are barraged by.  And I just want to say bologna!!  BOLOGNA!  Real women are really beautiful for many reasons including, but not limited to their bust, waste and hip measurements.

I feel so passionate about this right now, I want to start a hashtag campaign for #RealWomen to take pictures of their real selves and post them on social media.  (I just looked up the hashtag RealWoman... don't do it.  It's already being used and perverted... So much for the hashtag campaign idea.  I guess I'll just post an obscure blog.)  I wish we could flood the media with what real women look like and see how beautiful we are with our various struggles and body types.  This passion rises in me as a 42 year old, six-foot tall, blonde, fair-skinned, fairly thin woman who has been told most of her life by various people, "You should be a model!"  All my life I have really dreaded hearing that from people.  I mean I know they're being nice and all, but being a model isn't the pinnacle of feminine beauty and it's certainly not what I want to do with my life.  Unless, I could be a model and show the extra roll of padding that has formed around my waist-line in the last 10 years, and the varicose veins that have disfigured my legs, and the painful-bloated abdomen that bothers me about 2 weeks out of every month simply because of ovulation and menstruation.  If I could show the world what I really look like no modeling agency would have me, because, well, I'm a real woman.  I have a real body with real fat and muscle and bone that don't conform to the cover of Vogue.

So I'll never be a runway model, and I never want to be, but I do model for my husband and sons and co-workers and nieces and nephews and kids at church and in my neighborhood what a real woman looks like and what makes her beautiful.   So what does make a woman beautiful?

The design of the feminine physique is un-mistakeably a thing of beauty.  No doubt, God made a woman as a display of beauty unchallenged by the rest of his creation.  In fact, the physical beauty of a woman is the reason the perversion, molestation and objectifying de-humanization of it is such a thriving industry both in the sex-selling advertisements used on everything from cars to hamburgers, and in the get yourself air-brushed, lifted, tucked, waxed, tattooed, slimmed, dieted, toned and trimmed messages we hear on advertisements everywhere.  We are being told constantly that the female body is beautiful if it makes a man want to engage in sexual acts with it, and if it is physically fit enough to compete in a modeling or fitness competition.  But the truth is, the female body's beauty isn't just like an exotic flower that's stunning and visually alluring for a time, and then, eventually wilts and fades.  It does wilt and wrinkle, fade and age-spot.  But the physical allure of a woman's body is also like fine wine and a timeless piece of architecture- it's beauty develops depth and variety and character over time and gravity and arthritis.   It really does.  The secret to the beauty of a woman that endures time and brokenness is not found at Ulta or the gym.  It's not confirmed in a man's arousal or an elite-fitness award.  This is where the God part of my soapbox on #RealWomen comes in.

I can't avoid it.  This is the thing about thinking through a line of reasoning.  If I leave God out of it, I could say a real woman's beauty comes from good character and trying to stay healthy.  No God needed.  But the motives behind the woman's good character and trying to stay healthy are the real light shining out of the lamp of that woman's life and if the motives are self-actualization and self-fulfillment as defined by other women and men in the world, then the light is a deceptive allure to a dead end.  But if the motives behind the woman's good character and work towards good health is the imaging of God's beauty and worth then she shines a light so bright it breaks through the thickest fog of depression, cancer and loss a real woman lives with, giving her the hope of also becoming a stunningly beautiful woman.  The light that shines from the life of a woman who's hope is in God, not in men or women or society, drives out the darkness that comes with sagging skin and hearing loss and clears the path for women with silhouettes and shapes of all kinds to walk the way of #RealWomen beauty.

God in Christ is the standard of #RealWoman beauty.  He's the creator of it and it's to him I look for what real beauty is, not magazines or what the world around me says.  He says real woman beauty is a gentle and quiet spirit.  He says real woman beauty is fearing no one but God alone.  He says real woman beauty looks fear in the face and laughs, cause nothing can drive out the unapproachable light of God's truth and his good plans.  He says the really beautiful woman knows she's a child of God, and like Christ, lays down her life- submitting to others willingly, and standing firm in the truth unwaveringly.  

I want to look to him for what beauty is and spend my time and energy striving after those things with the strength he supplies.  The physical maintenance of my body and the painting of the house must be done.  But they are not the methods I want to use to achieve beauty.  They are outward, temporary maintenance not inward lasting beauty.

Are you a real woman?  How do you define feminine beauty?


Sunday, September 4, 2016

An Unlikely 23 Years

 Wedding Day- Sept.4, 1993

Connor's birthday- April 1, 2003

During our first separation and pregnancy with Ryland- November 2004

Seeking a new start in Arizona all together- October 2005

 Second separation March 2010

Still together on a desert trail- Spring 2015

Today has been a tough day, emotionally.

Twenty three years ago today I made a vow before God and about 100 family and friends to take James as my husband, to have and to hold from that day forward, for better, for worse, for richer, for poorer, in sickness and health, till death do us part.

Those are some serious promises.  Better, worse, richer and poorer, sickness and health have all been part of these 23 years.  Honestly, most of it has been hard.  We weren't a very likely match at 19 and 21.  He from the big city, me from a small town.  His dad a pharmacist, mine a log truck driver.  We met in a child development class, taking pre-reqs for nursing.  He hated it.  I loved it.  He had long hair and torn jeans and loved Journey.  I was on fire for Jesus after having decided to heed the call to follow him a year previous at 16.  He was raised as a Catholic, but more as tradition than devotion and by his teen years religion was not on his radar at all.  He had already been in a very serious relationship and at it's end decided to move to Roseburg, Oregon from Phoenix, Arizona to take his dad up on his offer to pay for college as long as he lived at his house.  I had never had a true boyfriend.  I liked a couple of different boys, but that's about as far as it went.  One guy from my youth group at church was really trying to win me, but I thought of him as a good friend and not a boyfriend or potential husband.  And then I met James.

We had a few conversations during the breaks at our evening child development class at Umpqua Community College.  He teased and asked me to share my chocolate cake and wondered what kind of music I liked.  I thought he was handsome and talked about my favorite Christian artists and invited him to church.  He came.  He met my family, played basketball with my dad and brother, went to the beach and camping with my friends while I worked as a C.N.A. at an Alzheimer's facility, and on Easter Sunday he wrote me a love note.  I would say we started dating after that, but it really wasn't dating.  In fact, I think we only went on maybe one or two "dates" before we were married.  Most of our time together was spent at either my house or his dad's house, church or after work talks.

I was head over heels for James almost immediately after we became an official couple, but because of my convictions as a Christian, my relationship with him between April of '92 and September of '93 was stormy and full of indecision, conviction, guilt and desire.  I knew, after 8 months of hanging out with each other that we did not share the same desires in life, but the desire to be with him and the dream of being married and on my own and having my own family overtook my conviction that we were not heading the same direction in life.  Storming around my dreams, desires and convictions, the emotions of that time made it very hard to discern what I just wrote.  If you were to have asked me then how I felt about James and marrying him, I would have said I loved him and believed we would grow together.  I was naive to say the least.  On Christmas of 1992, the same year I graduated from high school, James proposed to me and I accepted.  On Labor Day of 1993 we were married at the church I grew up in.

In the past 23 years we both have come face to face with the reality that we want different things in life.  Through 2 separations and the birth of 2 sons we're still married.  I'm sure that means something different to him than it means to me.

Over these 23 years I've learned that life is not about me, it's not about my marriage, it's about Christ.  The trials and fires of this unequally bound relationship have caused me to wrestle with God, ask hard questions, face hard answers and no answers, and come to grips with what I really believe.  I believe I can't really know who I am, or why I am or what marriage is, or how relationships work best until I know God in Christ.  I believe marriage is his creation and has little to do with romance and anniversary presents and wedding rings and much to do with displaying how Christ has self-sacrificingly and faithfully loved his people.

I believe happiness in marriage ebbs and flows.  I believe in toughing it out when everyone says you shouldn't stay in a marriage where you're not happy.  Every married person is not happy with their partner at some point.  It's inevitable. We're human.

I met a couple at work the other day who have been married 59 years.  While talking with them about the significance of that, the wife said she didn't believe it was good to stay married if you weren't happy.  I was taken back.  Here was an 80 something year old woman who had endured 59 years with a real man (not a contrived romantic ideal as seen on t.v.) telling me a person who isn't happy shouldn't stay married.  In my surprise I asked, "I bet you're glad you didn't give up on this marriage when you weren't happy somewhere in those 59 years or you wouldn't be sharing with me the achievement of being married this long?"  She conceded and admitted there were unhappy times, but that they were too broke to afford a divorce then.  She was glad of that now.

We've looked divorce in the eye a couple of times in these 23 years,  I'd be lying if I didn't say those eyes were alluring and I still catch a seductive glance from them now and then.  I can't say with pride that I'm a woman of my word and I made a vow and I'm going to keep it.  Nor can I say that I am doing it for the kids or grinning and bearing it.  So what's keeping us together?  I can't speak for James, but for me, it's love.  Real love.  The kind that is happy to make the beloved happy and hurts when the beloved hurts.  The kind that endures brokenness and offense and strives for forgiveness and reconciliation because it wants to be close to the beloved.  I wouldn't know this kind of love were it not for Christ.  I've looked around and have seen a few other examples of "love" in the world.  None compare to the love of Christ.  And his love is in me.  And I love James.  It's that love that binds that vow I made before God through every minute of every year with him like flesh and bone and vessels.  We were James Dougal and Sheila Deane.  And God made us one.  We are bound to each other through this life and it's the love of Christ that binds.

With all that in my heart every day,  I woke up today and faced the hard reality of Sundays:  I love to gather with Christ's local church and worship him together and receive his heralded word and my husband does not.  And, at this point, neither do my kids.  My oldest is more vocal and defiant about it right now.  My youngest goes cause he wants to be with mom.  This is a deep ache in my heart that spurns a constant pleading with God for salvation to come to this house.

So it was an emotional day.  My husband worked in the yard.  Connor metal detected for coins in the yard.  Ryland worked on a school project.   My eyes were heavy with hot tears all day and they spilled out a lot while I sang to Jesus at church and drove between errands alone.  I read a Psalm today that defines what I long for in this 23 year old unlikely marriage and precious family:

Oh magnify the Lord with me, and let us exalt his name together! -Psalm 34:11


Monday, August 29, 2016

Lessons from a Monday

I worked a 12 hour shift today.  It was a good day.  Less stressful than the day I wrote about here, but still busy.  A good busy.  Not a I-have-no-idea-what-happened-in-the-past-12-hours busy.  We had a couple of admissions at the end of the shift which made for a very busy end of shift. 4 to 7 PM went by in 5 seconds flat and I accomplished about 20 things in that period of time in an ever-changing order of importance.

After work I drove to my son's club baseball tryouts and listened to the 11 year old version and 44 year old version of The Wallet and Tablet That Was Stolen From the Truck story.  I watched the 13 year old make a couple of great hits (or crush the ball as he would put it) and then drove the 11 year old home so he could be in bed before 10:30.

While I was driving home some small epiphanies were dawning on me:

  1. It's so helpful to try and understand another person's point of view.  Trying to explain to a frustrated nursing assistant why I could understand her frustration with patient so-and-so but if she could just try to put herself in patient so-and-so's shoes she might be less frustrated, I realized what a gift it is to be able to be a nurse. A nurse gets patients of all kinds.  Patients are people.  They had moms and dads, whether they knew them or not.  They may or may not have kids.  They had jobs and previous battles with illness.  They may have estranged children and unconventional living circumstances.  They probably have a story behind their rudeness, or impulsivity, or confusion, or fear, or flat affect or foul smell.  Taking the time to listen to people (patients) takes time.  Time away from charting and tasks on the task list.  And that's ok.  Taking time to listen makes a difference in people's lives and makes us better people.  Nurses get to do that in a way most of us don't.  When the cashier is rude at the checkout we don't really have time to ask them about where they're from or if they have kids or why they are where they are.  But nurses do.  In fact, admitting a patient to the hospital can be a great exercise in listening and trying to understand another person.  It's a special opportunity.
  2. One should never leave a wallet full of cash ($430 to be exact) and an electronic tablet sitting in an unlocked car at a high school while one drops one's child off at baseball practice.  This a mouth-full of humble pie for one who is a law-enforcement officer.
  3. The Christian Church should be like a good nurse:  She seeks the wellness of those who come to her even if it seems to hurt them at times.  She does not condemn the broken ones who come to her for being broken.  She gives of herself to minister to them the orders of the Great Physician for their wholeness.  
  4. My thoughts after reading 1 Peter- If you can't love and serve the foul-mouthed, arrogant, perverse, flippant, reckless cranks and jesters around you while refraining from the foulness, arrogance, perverseness, flippancy, complaining and levity they slander you for not joining them in, you haven't really begun to taste Christ in you.  Christ in you is what it means to be a Christian.  And Christ in you will compel you to lay down your life to love and serve others with grace and truth whether they malign you or praise you.  Whether they cherish you or take advantage of you.  Whether they treat you with respect or utterly disregard you. Because you want them to join you in the joy of being brought to God.   I've barely begun to taste and I want more.  It's crazy.
All on a Monday.

"For Christ also suffered once for sins, the righteous for the unrighteous, that he might bring us to God..." 1 Peter 3:18


Tuesday, August 23, 2016

a 12 hour shift

(I have no pics of my work in rehab, so this image of working with a traumatic brain injury patient is from )

I don't write about my work as a R.N. very often, mostly because there's so much that's confidential. But today I feel like I just need to process what happened in the 13 hours I spent at the hospital. Maybe I'll comprehend why my feet throb and my brain won't shut off and go to sleep.

I don't work in an E.R. or I.C.U. or any critical care conditions.  I work in an acute rehab unit.  Most nurses I work with yawn when they think about the nursing work in rehab.  You only have to chart an assessment once a shift.  No one's on a monitor.  You don't have very many patient's on I.V.'s.  And for the most part, the patients are stable.  So when I go home exhausted, feeling like I ran a marathon, my feet ache and I'm pretty sure I didn't document what happened all day very well, I feel a little like breaking down what it is I did all day and saying, "I know it's not critical care, but it's rehabilitative care and that is very labor-intensive and teaching intensive."

Tuesdays and Thursdays are conference days on my unit.  Every Tuesday and Thursday the patients individual situations are reviewed in a closed-door meeting of the PPS Coordinator (I still don't know exactly what that means but it's the RN who deals with medicare and justifying patients' needs for acute rehab), the Physiatrist (that's the rehab physician), the OT (occupational therapist), PT (physical therapist), SLP (speech language pathologist), CM (case manager), RN clinical manager, and RN caring for the patient.  Depending on how many patients are on the unit this meeting can take anywhere from 5 minutes to 2 hours.  Today it took 2 + hours.  This occurs while these same therapists and floor nurses are carrying a load of 4-6 patients on the floor that day and bouncing like ping pong balls in and out of the meeting to give their input on the patient, listen to the team's input, and come up with a potential discharge date.  Today I had 5 out of the 12 patients to bounce into this meeting to discuss, which meant my morning from 7 am to around 1pm went something like this:

  1. Get report from two night shift nurses about my 4 patients and the 1 patient a float nurse (a nurse who came to care for patients on our floor but is not a staff member on our floor) has so I can know what's going on with that patient since I will be doing the conference on that patient (float nurses can't do conferences on patients on our floor).  
  2. Sign into the EMR (electronic medical record) and begin documenting that I received report and what the fall risk and mobility score my patients are and what education I will be doing with them that day.
  3. Review the chart for orders, notes from doctors from the previous day, labs, vital signs, test results and medications that are due.
  4. It's now 8 am.  Conference begins at 10:30.
  5. Visit each of my patients briefly to introduce myself.  Do a general assessment just by talking with them (Are they alert and oriented? Any pain? Any nausea? Are they constipated? Can they urinate? Do they need O2? Do they have any skin concerns/wounds?). Take some patients to the bathroom.  Get some of them out of bed.  Get some of them water.  Get some of their breakfast trays set up.  Call a CNA to come help pull someone up in bed.  
  6. It's now 8:30 am.  Two hours till conference.
  7. Go to the Pyxis (the machine that dispenses the medications) and begin pulling 9 am medications for my patients.  I pull the meds for 2 patients since they're on the same hall, place them in different bags, label them and set out to look for a WOW (a rolling computer kiosk that I push around all day from room to room to give medications with and document my care of the patients) that works.  (It's about a 50% chance that the WOW you pick will loose it's battery life halfway through scanning your patients meds so you hope to find the one you know keeps a charge). 
  8. Answer the phone.  It's been ringing the whole time I've been in the Pyxis room getting meds and everyone else is either on the phone already or in a patient's room.  It's doctor so-and-so who wants to know who the nurse caring for patient such-and-such is?  I put him on hold.  Look for the assignment list.  Find the patient and their assigned nurse on the list.  Use the vocera (a clip-on phone device where anyone can get ahold of you anytime, anywhere as long as you've turned yours on and logged into it) to call the nurse who doesn't have a vocera.  I push my WOW to an outlet, plug it in and set out to find the nurse the doctor is holding for.  Finding the nurse, I stop to answer 2 call lights (call lights are patients pushing the red "nurse" button on the remote in their bed to get a nurse to come to their room), take an empty breakfast tray out of a room per the patients request and help a patient to the bathroom.
  9. It's now 9:00 am.  I start passing my medications. 
  10. In my first patients room I have a quick, easy assessment looking at wounds that are healing nicely, talking to a patient who's alert and oriented and has no new problems or complaints. But I do make note to follow up with the doctor about a question the patient had.  I pull out the meds, scanning the patients armband with a scanning wand exactly like the one in the self-checkout isle at Sam's Club.  It beeps.  The right screen pops up.  The computer confirms that I have the same patient that the patient reports to be by telling me their full name and birthday- I can proceed.  I scan each medication telling the patient what it is and what it's for if they don't already know.  The patient complains of constipation so I make a note to bring back a medication later to help with that.  I ask if there's anything else I can do and since there's nothing I let them know I'll be back to see them throughout the day and hand them their call light so they can reach me. On to the next patient.
  11. It's now 9:15am.  My vocera goes off.  Dr. So-and-So is on the phone for me.  I push my WOW to an outlet, plug it in.  Walk to the nurse's station and answer the phone.  I give the Dr. a report on their patient, hang up and return to my WOW.  On to patient number 2.
  12. In patient number 2's room I find a lot more to do.  The patient is in bed.  The breakfast tray is on a bedside table 10 feet away from the bed, and the room is dark.  I introduce myself.  Ask if the patient would like to get up and eat breakfast (In rehab we don't leave patients in bed for meals.  All patients, if at all possible, get out of bed for all meals).  I open the blinds to let some light in.  Patient #2 would like to get up.  I plug my WOW into the outlet in the patient's room, take the medications with me and set out to find a CNA or willing RN to help me transfer the patient (who requires 2 people to assist with transferring from bed to chair).  The nurse's station is empty, a phone is ringing, and 2 call lights are going off.  I answer the phone.  Patient such-and-such's family member would like to speak to the nurse caring for their loved one.  I place the person on hold, vocera the nurse and converse with a doctor who showed up at the nurse's station after exiting my patient's room.  We discuss some changes and I get orders for some thing's he'd like nursing to do for his patient.  I make a mental note and call for a CNA to help me with my patient.  Together we transfer this patient from their bed to the wheelchair.  I've performed some of my assessment in talking with the patient and transferring them.  I complete the assessment with a listen to their heart, lungs and abdomen and a few orientation questions: What's today's date? Where are you?  Why are you here?  I go on to ask about pain or any other issues or complaints.  The patient shares with me a couple of big concerns.  I note them on my "brain" (a piece of paper I scratch notes on all day) and begin scanning the patient's armband and medications.  I discuss the plan of care for the day and the changes the doctor wants implemented.  I ask if there's anything else I can do before I leave and then exit the room with a promise to return every 2 hours to carry out the new treatment ordered by the doctor.  
  13. It's now 9:50.  I head to the Pyxis room to get medications for patients #3 and #4.  On my way into patient #3's room I'm flagged down by the WOC,RN (that's the Wound, Ostomy, Continence RN) who would like me to assist her in the assessment of wounds and dressing changes in Patient #2's room.  I let her know I'll meet her there in a few minutes.  I continue into Patient #3's room and perform my same routine of intro, asking questions, assessing the patients condition and discussing the plan of care for the day.  This discussion included plans for discharge today and the patient's concerns and questions about how it was going to happen. While discussing and assessing I was also scanning the patient's armband and medications to give them quickly knowing I was needed in the other room to address wounds.  I made quick notes on my "brain" about the patient's requests for PRN meds and asked if there was anything else I could do.  I left the room with a promise to return with the requested medications.
  14. It's now 10:10.  Conference begins in 20 minutes and I still have a half a dozen wounds to address, another patient to give medications to and another patient (who wasn't my assigned patient) to assess so I could give some input on that patient in conference.  
  15. I go back to Patient #2's room, assist the wound RN in undressing and redressing wounds.  We find more wounds that we were expecting.  I leave the patients room to go gather more wound care supplies, return to the room to finish what we started and get called out of the room via my vocera 20 minutes into our care: They are ready to start the conference.
  16. I leave the wound nurse to finish what she's doing and head to the conference with my notes in hand.  It's 10:30.
  17. 30 minutes later I emerge from the conference on my 1st of 5 patients and call for the next nurse on the list to trade me places.  Their turn to discuss their patient.  I leave the room with notes in hand about all the requests the doctor made for me to follow up and the concerns brought up by the therapy staff and case manager.  I set my notes face-down at the nurse's station and set out to patient #3's room.  
Ugh.  I'm tired already and it's only 11am on my recall of today's events.  What transpired from 11 am to 1 pm was a cacophony of call lights, phone calls, vocera calls, medications scanned and given, following up on things not done yet that were noted on the original visit to patient's rooms, intermingled with 4 more interruptions to go to the conference room and discuss my patient with the team.  By 1 pm the conferencing of our patients was over, I was hungry, and way behind on charting.  

In nursing there's a saying:  If it isn't charted, it didn't happen.  Every assessment, every discussion (which is education), every intervention, every phone call to or from a doctor, every order, every vital sign, every medication, every treatment, every meal, every drink, every void, every stool, every transfer, every change in position...every interaction with a patient must be charted in the electronic medical record- or it didn't happen.  I estimate it takes about 4 hours of accumulated time to chart throughout the day.  Most of it is interrupted charting.  Interrupted to care for patients.  Which must be charted. 

I took a lunch at about 2 pm with only my assessments charted.  Half hour later I returned to work on my patient's discharge from the hospital.  The case manger is usually the person who takes care of arranging the medical equipment, transportation, follow up appointments and facilities needed for a patient's discharge.  But sometimes those things fall on the floor nurse.  Today they fell on me.  From 2 to 7 pm, when my patient finally discharged from the hospital,  I was on the phone with various entities to work out complications in the discharge plans and needs so this patient could leave and go safely.  Those 5 hours were interrupted with giving medications, addressing wounds and assisting with my other patients needs along with answering call lights and more phone calls.  

At 7pm when the night shift showed up and I said goodbye to my patient who finally got to leave the hospital,  I hadn't even begun documenting all that was required for me to chart from the shift.   I gave report to the night shift nurses and then sat down to chart.  An hour and 15 minutes later I was done.  I had completed the required documentation... I think.   (Did I mention that in a rehab unit there is an entire additional hour or so of charting that medicare requires from nurses to justify a patient's stay in rehab?)

8:15ish PM I clock out.  Walk to my car.  Drive home exhausted.  And when I've said goodnight to my kids, showered and sat down to unwind before I go to bed, I feel my throbbing feet and recognize the questions still running through my mind, and I think, "What happened today??!"

If you're ever a patient in the hospital you should know your nurse is probably running her tale off.  If you see her at the nurse's station on a computer, she's not sitting there doing nothing.  She's trying to make sure what she really did today is documented so that if anyone goes looking, it happened.  If you have a good nurse she won't mind if you ask her what medications you're taking or question what she's giving you.  She'll be glad you are being an advocate for yourself and gladly tell you what you're taking and answer any questions you have.  She'll listen to you and talk with you and make sure you're doing ok and then she'll have to go back to her computer and punch keys and scroll through doctor's notes to make sure she's recording what really happened and doing what really needs to be done that day to make sure you get better.  

I would really like someone to invent a charting robot.