The pain scale.

Here I am contemplating at least, my last few shifts as an ER nurse.

Of course, all of this could fall through and I could have years and years of ER nursing ahead of me.  Hey, there are worse things.  But, if this is to be my last stint of ER duty, even for a while, I want to get a few things down and thought I would share.  For those of you here only for adventures and pretty pictures, come back soon.  They will return. 

Now...sit down with any ER nurse and ask them about the pain scale.  At the very least you will get a groan and an eye roll.  Some, like myself, will go off on a passionate rant about the misuse and abuse of the standard 1-10 pain scale.  This sounds like it isn't a big deal, but it might be more so than you think.

Let me tell you why.

First off, when you come in complaining of pain, we take you seriously.  You took the time out of your busy day to come all the way down to the ER and probably waited a pretty good amount of time in the waiting room to boot.  Obviously this is more than just a minor boo boo.  (Except when it isn't, but that is another rant.) I get that you are trying to convey to me the serious and urgent nature of your pain.  Again, you are here, that tells me something.  Telling me you have level 10 pain because your ankle hurts, or even your stomach hurts, doesn't do that.  The first thing that does, is prevent that pain from ever getting worse.

You see, the scale only goes to 10.  Yes, even if you insist your pain is 25.  So, when your migraine gets worse, or your back starts hurting from lying on the junky ER stretcher mattress for a couple of hours, there is no way to document that.  The computer will only allow an entry up to 10. 

Your pain got worse?  No it didn't.  10.

One guy I worked with, definitely of the ranting variety, would ask people who rated their pain a 10, "So, if I set you on fire right now, you wouldn't notice?"

It gets irritating.

Especially when you arrive and are texting your friend about OMG you are at the hospital and eating the bag of chips from the vending machine in the lobby while you tell me your belly pain is a 10 out of 10.  Look, if you won't take this seriously, why should I?  I have a guy next door with 6 out of 10 chest pain for the past hour.  Who do you think is getting my time?

But, the real reason is different.

The real reason is that I have seen people in level 10 pain.  Most ER personnel have and it can be quite the profound experience.  You see someone who is gravely hurt and fading in and out of consciousness.  Every moment they manage to stay awake they are crying and begging for medications maybe you can't give them because their blood pressure is too low from all the blood they lost.  Frequently, the pain overwhelms them and they fall into animal screams before they lose consciousness again. 

So, what was your pain level again?  Let me give you a clue, if you can tell me it is a 10, it isn't.

Please, respect the pain scale.  It can be useful if used properly.

For a good example of what I am talking about, look here:  Pain Scale

The ER kicked my butt.

I doesn't happen often. 

Yesterday, the ER won. 

I am good at my job.  Much of that arises from a time when I wasn't very good at my job.  Not being very good at your job when someone's life or health depends on your proficiency is a very stressful situation.  That stress leads you to work hard on getting better or it burns you out.  I worked hard and got better and my stress level at work decreased to an acceptable level. 

But. 

And that is the nature of the emergency room.  You never know what is going to happen. 

Yesterday started off well enough.  I was busy, but nothing too bad.  Then a DKA arrived.  For those who don't know, these are somewhat personal for me.  These are possibly life threatening emergencies and they deserve as much of your attention as you can spare if you are the nurse.  While I was getting that all settled in, my sepsis arrived.  Systemic infection that can be life threatening.  Good times.  Dehydrated to the point that I couldn't find an IV site.  Luckily, my co-worker came to my aid with an ultrasound, just in time for them to tell me about the STEMI that was arriving into my other room.  Everything else stops for the STEMI.  This is an evolving heart attack.  Time is tissue.  We had a lot of work to do to get this guy to the cath lab within the window.  Again, without a couple of co-workers, this could have gone badly.  Even with all the help, I was starting to get a bit overwhelmed. 

We get the STEMI out and up.  I walk back over to my sepsis, to try to get back up to speed with where I was and what needed to done.  They tell me there is now a code stroke coming into the room where the STEMI just left.  It isn't even clean yet.  Oh yeah, I have another room with another patient I haven't even mentioned. 

This is the point where I realized something has to give. 

Mind you, this happened on a good day, in a good hospital.  At the morning meeting they informed us that we were 'upstaffed' today.  And even though we had an extra nurse, my charge wasn't going to send anyone home  just in case. 

So, working in my favor was an extra ED nurse, a charge nurse that was good at recognizing and fixing problems as they crop up, and a pretty well run hospital.  Without any one of these things, this could have been a lot worse.  It reminded me of other places and other times when I was not so fortunate.  Sometimes these things happen when you are down a nurse, with a green charge in a place that cares more about saving money.  I've been there too. 

I'm tired.  I need a break from all of this.  Is it weird that I am looking for a more sane work environment in a prison?  Probably.

I am pretty sure though, that I won't have to do urinary catheters on 2 year old kids and CPR on 90 year old people.  I guess I will see. 

Yesterday, everything worked out thanks largely to my coworkers.  We got everything settled and I even got sent of to lunch.  Then I returned to the new patient that wouldn't stop pooping on himself.  Some days.

And on this day I broke a little.  As I have before.  When I got home my family put me back together again, like they do.  I will go back again later in the week and try again. 

It's time for a change.

I'm ready.

Return to Point Reyes.

To cap what has been an amazing stretch of visits with people I don't get to see as often as I would like, we have family in town.  My dad and step mother Julia are up visiting and it has been very nice.

If this were the Silverdale contract it would have inevitably been Murhut Falls.  Our standby destination here though is Point Reyes.  It is close and pretty.

Remember Point Reyes?

It looked like this.

And this...

No brainer, right.







So, after a late lunch/breakfast, we were off.  They got a rental car for the week and followed behind us along the way.  I tried to be good, I really did, but I just had to stop and get a picture or two along the way.  Sarah eventually got used to me swerving off the road at inopportune moments to catch some potential picture. I told them as I passed their car that this was just one of the occupational hazards of traveling with the Adventure Nickel.  Julia got out of the car and thanked me for stopping so she could get her camera out of the trunk.  She had been mentally framing pictures the whole way and cursing for leaving the camera out of reach.  Ahhh, fellow shutterbug.

Ahhh, the light is perfect.

Then...suddenly, this happened.

Hey!  Wait a minute.  But, if there is fog all over the place, I can't see anything!  The pictures are going to be terrible.

You're going to have to trust me, there is an ocean out there.

Well, the scenic vista isn't what it should be.  How about the wild life?  Last time there were deer and hawks and cows and stuff everywhere.  What about this time?

Seriously deer?  Really?

Did that deer just call me a pervert?

Oh well, I guess we should just drive back.  Nothing to see here unless you want all of your pictures to look the same.

At least the hawk cooperated.  Thanks for not pooping!

Cows of the Mist.

We decided to head back to North Beach.  At least we could get a good sound of the crashing waves.

We were able to watch a tremendous rip current. 

OK, I tried to replicate this as closely as possible in the conditions.

This is the last trip here.

Beautiful.

 This time.

Bleh.

Oh well, make the best of it.  Be goofy and get back into some sunshine.

I take picture of you taking picture of me.

Pretty ice plant flower.

Still in the fog, I had to stop and take this picture.  Someone on the Google + photography page put one of these up and I recognized it.  So, I STOLE it.

BWAH HA HA HAAAA!

Eventually we got back out of the fog.  It was a thick and pretty fast moving bank of fog.  So we had to stop and take some pictures.

 Often, the best light, and pictures, can be found by turning around.

Works for sunrises and sunsets too.

So, we decided we would just have fun stopping to photograph everything of interest as we drove home.  They don't all work out like you plan, but they usually work out.

Not Das Boat!

Birds circling in a thermal

Change is hard

No matter how often you do it. 

What's that you say?  Change is hard for the cast and crew of the Adventure Nickel?  Balderdash!  Poppycock!  You guys change everything up all the time!

Kind of. 

We move locations around every three months.  We change addresses, grocery stores, entertainment venues, running routes, everything.  This is change we are good at.  We have done it so long now that this change is normal.  It barely counts as change.  OK, so it is still an obstacle, but a known one.

True change is scary.  True change is identity level stuff.  What are the names we call ourselves?

Are you a smoker?  Corporate worker? Martial Artist? Wage slave? Drug addict?

All of these things are part of who we think we are and it is scary to change who you are even if it is sometimes good for you. 

Travel nurse?

Wanderer?  Explorer? 

True change is hard...and scary.  Going from a suburban homeowner and staff nurse to a RV living travel nurse was identity level change and it was scary and stressful and worth every bit of it.

Going back to a stationary life with a regular job is scary too.  I don't know what we will do, how it will work out or whether there will be a continuing blog, but we have decided it is time to try this idea out and see what comes of it. 

Just like the cruise ship, the escape hatch of traveling as an ER nurse will still exist, but we want to give this an honest try. 

Oh yeah, about that ER nurse thing.  It may be time to give that a rest for a while.  I don't talk about it on here much, we try to keep it upbeat and family friendly, but working ER can be hard on a person. 

All that being said, we plan on settling down in Washington with me working as a nurse in a correctional facility for a while.  You didn't expect me to go completely normal did you?

It's been a while

Hard to believe it has been over a month since I last posted something on here.  Shameful.  Go ahead, dock my pay.  I deserve it. 

It isn't that there has been nothing going on.  In fact, just the opposite.  There has been a lot going on.

We went to Houston to visit the world famous Papa and Grandma.  That was awesome fun, but I forgot the good camera.  Most of it would have just been pictures of me sitting on a couch with food stuffing into my face and a drink nearby.  Great times, just not particularly photogenic. 

So...to make up for the lost time - come back big or don't come back at all...I present to you.

Oh yeah.

We have a friend, Annika, who lives not too far from Yosemite.  She graciously agreed to watch Satchel while we were visiting in Houston.  Yep, she was willing to dog sit for three weeks.  We noticed that she only lived about 90 minutes away from Yosemite.  You do know that is one of the bestest national parks out there right.  This is bucket list level stuff.  We had to go.  It was a beautiful weekend and we were off. 

But first.

There were a couple of things of note, prior to our arrival at the park. 

California is in a drought.

Please, no fishing from the bridge

 This is very similar to what Lake Shasta looked like when we drove through that way.  Water is a precious commodity, please don't waste it.  This story is the same all over the state. 

There is another side effect of the drought.  We got our first taste of it on our way out to the park when we stopped at ...

This overlook was where they derived the name for the Rim fire which burned 257,314 acres in late 2013.

There used to be trees

Contemplating the devastation

But, enough depression, we came for the pretty stuff.

And Yosemite doesn't disappoint. 

There it is, the distant sight that beckons.

See. we were there.  I'm not that good with photoshop.

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Straight down the valley.

Driving deeper into the valley, we encountered some superlative examples of one of our favorite things. 

Waterfalls.

Bridal Veil falls.

At this point, I was reasonably overwhelmed with awesome.  Then there was this guy. 

Unfortunately being fed by passing cars.

There was so much going on.  I don't really know the layout of the park either.  I hadn't even seen a map, really.  You could see half dome off in the distance, but everything else was just pretty.  Like this.

Wow, what a pretty cliff.  I should get out the zoom lens.

Man, this one should have a name or something.

No wonder this is a rock climber's paradise.

 Then we got to a spot that I recognized.  As something of a waterfall aficionado, I knew that the tallest waterfall in the continental United States is right here in Yosemite. 

It was alternately cold and hot depending on sunshine.  I'm guessing it was cold at the base of the falls.

I brought the zoom lens.

Someday, maybe I'll splice three or four of these together.

One more...

We hit the visitor's center for some education and then it was time to get out on some trails.  There are enough trails out on Yosemite that we could hike there for an entire season and never repeat a trail I'm sure.  We had but one day.

And where, oh where, would our hike lead us?  Someplace, perhaps, near water.  Someplace we can scramble around on slippery rocks?

There are people in that picture

Here are our lovely hosts and dog sitters.  Thank you Annika, Arianna and Robert.

Michael posing for the camera.

Doesn't it look so inviting? Come, scramble around!

Annika decided to hang back and take pictures from the bridge.

Robert led the troops.

Hi Max!

We saw some climbers while we were up there.  I really need to get out and climb more.  It looks so fun. 

IT was cool watching these guys climb.

This one was particularly fun.

Going for some stretches and holds.  Very cool. 

Of course, we were doing some climbing of our own.

To the victors go the spoils!

The view is better from up high.

Somewhere back down there, Sarah and Annika are watching.

Par 3

Miss Muffler, rock hound

This guy too, great climbers

Right about here was when I realized these "Guys" were mostly women.  That makes it even cooler.

Pretty little stone bridge.

Oh yeah, this is still there.

Unfortunately, we had to go.  There was still a decent drive back, food, and the realities of real life that had to be dealt with.  It was amazing to go and see even a little bit and we really wanted to go back for more.  We need to get up close with Half Dome. 

And oh yeah, El Capitan.  Shouldn't we have seen it somewhere?

Annika, and the maps, informed me that we passed it coming in.  Somehow I hadn't noticed what I had seen.  Even though I took pictures of it.  So, we had to stop on the way back because...

It is El Capitan.

Majestic as @#$%

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Remember, it is 1/2 mile away.  Can you spot the climbers?

Now?

Brave souls

And this person all alone.

We are here!

And all of this happened by the most remarkable coincidence.  A chance encounter a few years ago.  Where, oh where did we meet the lovely Annika and Miss Muffler? 

Tough Mudder SoCal



Loved the trip, loved the visit, can't wait to get back.  Thanks Annika, Arianna, and Robert for everything.  We meet the coolest people.