Casseroles AGAIN?! - lament of a time cruched athlete-wannabe.

Many of my friends ask how I balance my training with my crazy work schedule, and with my "responsibilities" as a wife , (no, I'm not a slave, but the cooking, cleaning, and laundry responsibilities do fall on me).

I don't have multi-tasking down to perfection (D can attest to this).  Although as I write this blog, I am dual-tasking by spending quality time with my dog Fez in my lap (he likes to help when I'm on the computer by pointing to the exact key on the keyboard that I need).  Laundry and cooking is sporadic.  Cleaning, even more so.  Making sure D has underwear and socks falls ahead of mopping and vacuuming.  And thankfully I survive in either nursing scrubs or workout clothes so my wardrobe essentials are pretty minimal.

I'm thankful for the Elmwood Inn or the Otter Lodge to feed us when I don't have time (or just don't have the energy) to cook.  I've been known to have s'mores or a couple bowls of Cap'n Crunch for dinner and nothing else.  D lives off casseroles when I work - and I'm glad he really doesn't mind.

I don't have racing/training down to a science, either.  I'm not particularly fast (a middle-of-the-packer in mid-distance races), so I don't think that anyone looks to my mediocrity as inspiration, or a goal.

Although I "only" work 36 hours a week (three twelve-hour shifts), those shifts alternate between nights (7pm-7am) and days (7am-7pm).  I only have two patients, but as a Trauma and Burn ICU nurse, often those two patients will keep me on my feet all.  Shift.  Long.

For example, one day I had two patients who each had hourly evaluations (other than their vital signs) due to their mechanism of injury.  Add their medications, hourly vital signs assessments, charting, and helping the nurses to my left and right - it can get REALLY busy.  And often my legs feel like dead weight afterwards.

Thankfully I don't have to work a lot of weekends (two weekends out of every six weeks).  But that said, following a prescribed training plan is pretty much impossible.  I don't get to do my "Long Run Saturdays" or "Tempo Thursdays".  It just gets fit in whenever it gets fit in.  I miss out on doing community stuff, like Monroe Milers - something I would really love to do if I had a normal schedule.

I try to work my "three days" back to back, so I get some consecutive days off in between.  So on those working days, I concentrate just on the running.  I've found running tired (especially after a night shift) to be very beneficial.  I don't often have a goal for these runs, but I hardly call them "junk miles".  At times they turn into 5-mile tempo runs and I surprise myself.  Running tired helps you realize what you can push your body to do - something I learned a lot about when I was training for Sehgahunda 2011 (which was by far my worst race in terms of how I fell apart, but one from which I learned from).

On the days I don't work, I often cram in brick workouts (swim/bike or bike/run) or two-a-days.  I don't do specific "speedwork", and only occasionally get in a hill workout.  Over the past year I haven't been running trails as much, although I love running trails in the wintertime the most, so I see this changing over the next few months.  Once or twice a week I hit the pool at UofR.  I don't have a specific triathlon in mind right now, but as my body has responded well to multi-sport disciplines (both in health and my weight), I see this as being my direction go forward (my dream was once do to trail ultras, but as my ankle has been re-damaged annually on trails, I see 26.3 as my max limit on trails).

At times, I feel guilt for not being a better wife - I honestly do try my best.  D is busy too.  And our schedules do not mesh together:  We spend very little time together when you look at how many hours are in a week.  Often I may skip a workout altogether when he gets the rare early night home.  And so be it.

So, there is my (albeit poor) balancing act in a nutshell.  But over the past few months I can't say that it hasn't worked for me:  Since September, I placed third in my age group at a super-sprint duathlon, and I PRd in the half-marathon and 5k (both by over 90 seconds).  I guess these personal triumphs just affirmed to me that quality over quantity will reap decent rewards.  I know that my "success", as others may define it (i.e. consistent AG placing, or winning), will be very limited because I can only dedicate X-hours a week to training - and I refuse to sacrifice family and sanity any more than I have.  But considering that this girl only started running 4.5 years ago, I'm pretty darn happy with how far I've come.

I'll take the good over the bad.

The past several weeks in Rochester have been violent weeks.  It is safe to say, and assume, that any person one reads about in the paper, that was critically wounded, due to violence, is on the Kessler Family Burn/Trauma Unit at Strong Memorial Hospital.

Some did not make it, as you may have read.

Many did, and recovered miraculously with minimal impact.

A few of my patients - both victims of violence (VoV) and a few from traumatic accidents - had incredibly positive outlooks and plenty of humor.  Amazing to say, I really loved my past few weeks at work, because of my patients.

A co-worker, who just has a great rapport with every patient we have, asked one VoV I was taking care of: "how does a gentleman, who has been nothing but courteous and strong through all this, get himself (in this predicament)?"

My patient shrugged his shoulders, gave a little smirk, and said candidly - "Drinking!  But from here on out, all you'll see me drinking is Vitamin Water!"  While I expect him, or anyone, to have some hiccups in that road, the fact that he came to that realization speaks volumes.

Another patient, who for all intents and purposes should be partially paralyzed - if not dead - as a result of unprovoked violence but recovered relatively unscathed, had a great sense of humor, joking about how he could be a rapper: "Hey, I'm a statistic now!" he laughed.

And as me and a co-worker were getting ready to transfer him out of the ICU, I asked him if he would like me to call his mom to let him know he was being moved to another floor.  "Nah," he said.  "she's in church now, probably collecting a LOT of money now that I'm a miracle!" 

He even insisted on staying in the same bed he had in the ICU.  "Me and this bed have been through a lot.  This is my BED!  Got blood on it, peed on it.  We're really tight!" 

And then there was a trauma patient, who felt incredibly dizzy when I helped him sit up, and get out of bed to sit in a recliner, 2 days after surgery...

Dizzy he must have been - "Wow, I think I love you!" he giggled.  And as he stood up, he looked at the surgical resident to say "wow, you're a handsome fella."

It's hard to find some good on a unit that deals almost exclusively with all the bad in the world.  But the past few weeks, leading up to my vacation, reaffirms why I love this job so much!

Goals you set to achieve, and the ones that surprise you...

There always seems to be a benchmark for runners to cover at least 1000 miles within a calendar year.  Granted, many do more.  Every year I hope to run 1000 miles and have yet to make it.  This year, though,  I haven't beat myself up over it.

This year, I evolved in other ways.  I became a smarter runner, and learned a lot about what my body tells me.  I learned what limits I can push, what I can't, and what I need to do when I'm not running in order to be a better runner.  Good tools in the toolbox for 2012, when maybe I'll run 1000 miles...or more.

I did accomplish other things that were pretty important, though.   I graduated nursing school, landed a great job (two goals right there), and we are financially in a better place because of it - not that we were in a bad place, but things we needed - or even wanted - came a little bit easier now that we are finally a 2-income household again.  Being the checkbook holder in the family, I cut some unnecessary expenses (ex-naying the Cable, changing car insurance companies) - something I'm proud of.  Once in a while, I have to put my foot down with Dave when he sees a shiny new gun or pickup truck.

Thankfully after pouting for a half day or so, he sees things my way :-)

I'd like to think I'm a better wife now - Army (both my career and Dave's) and nursing school has been competing with that goal against my own intentions pretty much since we got married.

So, it's not all about running.  I always will want to be a better runner.  But as we start thinking about starting a family I am realizing that it needs to be incorporated into other things in life.  Well, actually, I've known that all along but it's only been in the past 6-8 months that I have been *okay* with that realization.  I have a lot of people to look up to for that...local runner Kim R. for one, continues to tackle ultras while working full time and raising three kids.  My godson's father, Pete F. who is a multi-tasker/hunter/gatherer/provider extraordinaire, in my opinion, will never cease to amaze me.

The potentials of being a mom (NO! I am NOT pregnant yet!  Don't start rumors!) are a bit daunting, but are challenges I looking forward to now.

Other things I have cherished over the past year were goals I never set out to accomplish in the first place. I have developed new friendships (bbmhfabgglz) with people who I really cherish today, cut ties with some parasites, and am generally in a happier place that I've ever been because of it.

So, in all, 2011 has been a great year - and I'm excited for 2012!

Simple rules for drug seekers in the Emergency Room

I am not an ER nurse now, but I've worked in ERs before - as a medic and a nursing student.  


While this "ad" on Craigslist is 4 years old, a friend of mine posted it onto Facebook.  I'll just say that it's full strength hilarious with (more than) a milligram of accuracy!  Enjoy!



Advice from an ER doctor to drug seekers

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Date: 2007-03-27, 9:56AM PDT

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OK, I am not going to lecture you about the dangers of narcotic pain medicines. We both know how addictive they are: you because you know how it feels when you don't have your vicodin, me because I've seen many many many people just like you. However, there are a few things I can tell you that would make us both much happier. By following a few simple rules our little clinical transaction can go more smoothly and we'll both be happier because you get out of the ER quicker.

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

The second rule is pick a simple, non-dangerous, (non-verifiable) painful condition which doesn't require me to do a four thousand dollar work-up in order to get you out of the ER. If you tell me that you headache started suddenly and is the 'worst headache of your life' you will either end up with a spinal tap or signing out against medical advice without an rx for pain medicine. The parts of the story that you think make you sound pitiful and worthy of extra narcotics make me worry that you have a bleeding aneurysm. And while I am 99% sure its not, I'm not willing to lay my license and my families future on the line for your ass. I also don't want to miss the poor bastard who really has a bleed, so everyone with that history gets a needle in the back. Just stick to a history of your 'typical pain that is totally the same as I usually get' and we will both be much happier.

The third rule (related to #2) is never rate your pain a 10/10. 10/10 means the worst pain you could possibly imagine. I've seen people in a 10/10 pain and you sitting there playing tetris on your cell phone are not in 10/10 pain. 10/10 pain is an open fracture dangling in the wind, a 50% body surface deep partial thickness burn, or the pain of a real cerebral aneurysm. Even when I passed a kidney stone, the worst pain I had was probably a 7. And that was when I was projectile vomiting and crying for my mother. So stick with a nice 7 or even an 8. That means to me you are hurting by you might not be lying. (See below.)

The fourth rule is never ever ever lie to me about who you are or your history. If you come to the ER and give us a fake name so we can't get your old records I will assume you are a worse douchetard than you really are. More importantly though it will really really piss me the fuck off. Pissing off the guy who writes the rx you want does not work to your advantage.

The fifth rule is don't assume I am an idiot. I went to medical school. That is certainly no guarantee that I am a rocket scientist I know (hell, I went to school with a few people who were a couple of french fries short of a happy meal.) However, I also got an ER residency spot which means I was in the top quarter or so of my class. This means it is a fair guess I am a reasonably smart guy. So if I read your triage note and 1) you list allergies to every non-narcotic pain medicine ever made, 2) you have a history of migraines, fibromyalgia, and lumbar disk disease, and 3) your doctor is on vacation, only has clinic on alternate Tuesdays, or is dead, I am smart enough to read that as: you are scamming for some vicodin. That in and of itself won't necessarily mean you don't get any pain medicine. Hell, the fucktards who list and allergy to tylenol but who can take vicodin (which contains tylenol) are at least good for a few laughs at the nurses station. However, if you give that history everyone in the ER from me to the guy who mops the floor will know you are a lying douchetard who is scamming for vicodin. (See rule # 4 about lying.)

The sixth and final rule is wait your fucking turn. If the nurse triages you to the waiting room but brings patients who arrived after you back to be treated first, that is because this is an EMERGENCY room and they are sicker than you are. You getting a fix of vicodin is not more important than the 6 year old with a severe asthma attack. Telling the nurse at triage that now your migraine is giving you chest pain since you have been sitting a half hour in the waiting area to try to force her into taking you back sooner is a recipe for making all of us hate you. Even if you end up coming back immediately, I will make it my mission that night to torment you. You will not get the pain medicine you want under any circumstances. And I firmly believe that if you manipulate your way to the back and make a 19 year old young woman with an ectopic pregnancy that might kill her in a few hours wait even a moment longer to be seen, I should be able to piss in a glass and make you drink it before you leave the ER.

So if you keep these few simple rules in mind, our interaction will go much more smoothly. I don't really give a shit if I give 20 vicodins to a drug-seeker. Before I was burnt out in the ER I was a hippy and I would honestly rather give that to ten of you guys than make one person in real pain (unrelated to withdrawal) suffer. However, if you insist on waving a flourescent orange flag that says 'I am a drug seeker' and pissing me and the nurses off with your behavior, I am less likely to give you that rx. You don't want that. I don't want that. So lets keep this simple, easy, and we'll all be much happier.

Sincerely,
Your friendly neighborhood ER doctor 

I'll sleep when I'm dead

For some reason, I drew the short straw when it came to working night shifts during orientation (which is 6 months).  Seems like all I work are nights.  In a way I like the night shift because you don't have dozens of consults, residents, attendings, chiefs etc. asking questions, so you can concentrate on your patients.  But I had a very complicated patient (the other was very stable) this week which took a bit out of me when I don't get enough sleep.



With three back-to-back night shifts I knew fitting in my running was going to be tough, but I got it done. One run was right after I got off work, and ironically was one of my best runs to date...

I had no clue where the mojo came from, but only hoped it would stick around for the race on Saturday, which I inadvertently signed up for not realizing that I worked until 7:30AM (and the race started at 9!)

The orientation program at the Burn-Trauma ICU at Strong Memorial Hospital is 6 months long.  In general, we spend about 16 hours a week in class or doing online education, and 24 hours a week in clinical (some weeks, like this week, we only had one education day).  With our group, though, we have yet to start the formalized ICU education program that will teach us the specific points of working in an ICU environment.  I'm anxious to get to start this, as with some of these complicated patients I feel I can only contribute in very shallow terms since we haven't started the ICU program, and frankly a general nursing education (baccalaureate or otherwise) barely skims the material you need to know.  I'm looking forward to a point where I know what the hell people are talking about.

Nights are hard to get used to, and I really only get about 3-4 hours of sleep in between shifts, despite wearing an eye mask, drinking decaf tea (my nightly ritual before bed) and even taking a melatonin.  So, going into Saturday's race with 12 hours of sleep (over 3 days)...well, it was going to be interesting.

Summerfest 12k was my 4th race in 3 weeks.  So, on top of little sleep and night shifts, my only goal was to finish and not do a face-plant until after the finish line.  Of course, I was hoping that my pace would fall into place as easily as my run on Thursday, but it was not to be.  I started out at about a 9:40-9:50 pace, but the heat (an unseasonably hot 84 degrees with high humidity), and the lack of shade got to me at about mile 3.5 or so.  The hills, not so much...I tackled them with reckless abandon until cramps got in the way.  So, I bagged any sort of pace goal and rolled into the finish with about a 10:30 min/mile.  Meh...I'm good with that.

Can't say it wasn't hot!  (photo courtesy Barb Boutillier)