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Peanut Butter Energy Balls: A Tribute to Nurses Week

Thankfully, I am feeling much better at work lately. It is amazing what 2 months can do. It’s still isn’t perfect, but the fact that I am posting a recipe again means that I am cooking again, which must mean that things are at least a little bit better, and I am a little less stressed. Nurses Week just passed. I was hounded by a couple of the ANCCs to write a story for an “anthology” of stories that was going to be published for the event. Naturally I agreed to do it, but only so long as my story was anonymous, and was only published if plenty of other submissions were received as well. As my luck would have it, my story was the ONLY submission received, and it was published alone, on the back of the nursing newsletter, which was distributed at a very public ice cream social. I didn’t find out until after, and I can tell you, without exaggeration, that my cheeks were as bright as my pink scrubs. Oy! But since the whole world has read my story (it seems) I guess you can read it too. But before that, check out these balls.

I made this recipe because I have been SO hungry at work lately! My coworkers joke that I always seem to be eating something…but I just don’t understand how they aren’t eating something, too! I am training for a half marathon and it is inevitable that some of my runs occur before work, even though that means that they precede a 12-hour cardio endurance event in the ER, which makes me feel that I just created a new Olympic event: the Nursing Duathlon. These energy balls are perfect to pop in my mouth between patients…or on a hike in the Catskills, or a long travel day cross-country to Seattle, the possibilities are endless. And it doesn’t hurt that the “energy” balls kind of taste like cookie dough.

Peanut Butter Energy Balls

Adapted from: The Diva Dish

Ingredients:

1/2 C pecans

1/2 C almonds

1/2 C chopped, pitted dates (I bought pre-pitted)

1/4 C carob/chocolate chips

1/2 C unsweetened finely shredded coconut (plus more for rolling your balls)

1/2 C quick oats

1/4 C pure maple syrup

1 tsp vanilla extract

1/4-1/2 C Peanut/Almond Butter (depends on how extreme you want the PB/AB flavor to be)

First gather your ingredients. In a food processor, first pulse together the pecans and almonds until you see chunky crumbs. Then add the dates and chocolate/carob chips and process some more until your mixture looks pretty crumb-y again. Next, mix in the coconut and oats (one at a time) and pulse until they are integrated. Lastly add the wet ingredients: maple syrup, vanilla and peanut/almond butter and process until they are fully incorporated. Scoop the mixture into a bowl (so the blade isn’t in the way), remove your rings 🙂 it is sticky! Start to roll balls. You can leave them “naked” (which I did for Matt, who has an unfathomable aversion to all things coconut) or roll them in a pretty dusting of coconut flakes (for me, who knows what is better) and then store them in the fridge/freezer as a snack for now/later!

Naked Balls

And now for a little post-cooking story time…

I eye the clock with apprehension. 6:52: my shift starts in less than 10 minutes. I pack my pockets with all manner of nursing paraphernalia; arming myself for the onslaught of patients during the 12 hours that lie ahead. A Carpuject, pulse oximeter, handy notebook of nursing diagnoses and interventions and plenty of saline flushes line my pockets, and my stethoscope is looped around my neck. With a deep breath, heart racing, I set off to receive report, wondering what sort of night lay ahead. It’s impossible not to wonder, but also impossible to control: this is life in the ER.

I thought I knew what to expect. I spent eleven eye-opening weeks as a student in the St Luke’s ER. But “Student Nurse” has a much different ring to it than “Staff Nurse.” As a student, I could apologetically shrug my shoulders and say, “I don’t know” to a patient, and come back with an answer later. As a registered nurse there is a much different expectation. Certainly, I can, and do, ask many questions. But I also feel the weight of responsibility in a different way.

Now, 8-months as a nurse, still green in many ways, I can at least look back on my first few months of being a nurse and see how far I have come. In the beginning, it didn’t take much to throw me off my A-game: a missing piece of equipment that I had to go hunting for or back-to-back “notifications” in the trauma room. Anything could do it, and often did, because the role of the ER nurse is to expect the unexpected and be comfortable feeling perennially behind. Every task is urgent…except for the ones that are emergent. My baseline emotion when chaos erupted was low-grade panic, punctuated by spikes sheer terror.

My confidence was (and admittedly still is) easily shattered. I can start IVs, administer medications and blood products, insert catheters and assist with other invasive procedures. I can competently help stabilize a trauma patient or efficiently do a cardiac work-up. And while I may not yet have the grace of far more seasoned nurses, I can feel satisfaction knowing that as I run around looking harried and crazed, I will get the work done.

It is only recently that I feel a small but perceptible transformation. Gradually, I anticipate what the plan of care will be for my patients, and find that I am correct more often than not. I assist my fellow nurses, like they so often help me. I feel a growing sense of familiarity and comfort with the staff, and realize that in knowing each other well, we work together like cogs in a well-oiled machine. But most significantly, I have started truly hearing my patients for more than their medical histories, and remember the real reason behind why I became a nurse.

One night, as I was busily scurrying around the ER, I picked up patient who had tripped and hit his head. When I went to see the patient, I found a man in his mid-80s, quite confused to find himself in the ER in the middle of the night and with a bloody forehead, to boot. I helped get him settled and explained the purpose of doing a CT of his head. With trepidation, he agreed. He miraculously had nearly no past medical history, and was staggered by the tubes of blood I had to draw for labs and bothered by the incessant beeping that came from the monitor whenever he pulled off his leads. Then, we were called to the trauma room and for 30 minutes I didn’t think about anything else besides the new patient in front of us.

When I eventually made it back to my older gentleman patient, he was agitated and disoriented. While his words came out in a tumble, I gathered that he was afraid, tired, annoyed and that he had soiled the bed. He told me that he had called for someone to help him but wasn’t heard and eventually couldn’t wait any longer. He was embarrassed, and rightfully indignant. I felt terribly that I had been holed up in the trauma room for so long, and apologized profusely. I helped change the linens and his wet gown. Now calmer, clean and settled, we spoke the plan for him to be admitted to the hospital, and I also learned about his wife of 60 years at home with whom he was still head-over-heels in love. In the end, I realized that it wasn’t the subdural hematoma that made my patient feel so scared and upset, but the feeling of being neglected. Everyone deserves dignity in their care and I felt reassured that despite my rush, I am still able to find moments in the ER to provide reassurance, listen to touching anecdotes, and care for my patients during their most vulnerable times. In nursing school, you learn about the progression of competence that every nurse makes in their journey to becoming experienced. It is gratifying to move past a near-exclusive focus on the completion of discrete tasks to the ability to view and implement comprehensive patient care based on individual needs.


 

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Donning Gloves and Gown, Entering Hospital Town

Ten years ago, I squirmed when I saw blood and guts. My best friend loved gory plastic surgery TV shows, but I couldn’t handle them. If someone had told the childhood version of me that I would be a nurse one day,  I would have told them that they had the wrong Rachel. An author, sure. An artist, why not? A TV news anchor, yes for a short time, I’ll admit it. But never, not ever, would I have guessed a nurse. All those personality tests we had to take in high school (Meyers Briggs, career assessments…) none of them correctly predicted my future path. Granted, if they had come back with “Nurse Rachel,” I would have rolled my eyes even longer than your typical high schooler, but little did I know…

In our accelerated summer program, we only have one day/week of clinical time. It is welcome relief from sitting in the lecture hall for hours on end with our bums molded to the weirdly shaped red chairs, hunched over our computers and notebooks, furiously scribbling/typing away. 8-12 hours of classroom time every day is enough to make anyone grateful for an intravenous catheter insertion demonstration (or in my case, hands-on experience). I ended up at a well-known hospital for my first clinical site. Not only did I get lucky with the location, but I was placed on a RICU floor (respiratory ICU) which is like jumping into a freezing lake: much better just to throw yourself in without knowing the temperature of the water. Our patients have acute medical conditions, and the majority are in respiratory failure. The first clinical day, we spent most of the time in the patient lounge with our preceptor teaching us about the floor; essentially a crash course in Respiration & Ventilation 101. We were overwhelmed. At the end of the day, we went in, as a group, to visit one patient. Our preceptor was going to demonstrate how to dress wounds, specifically a pressure ulcer, but it turned out that this woman, Senora Vasquez* had more pressing concerns. She does not have a tracheal intubation (rare for the floor) and just receives oxygen from a nasal cannula. She was able to tell us more about her own disease process that the chart could tell us (with occasional reminders from the preceptor). I noticed that her bed was wet and wondered if he urinary catheter bag was leaking. Our preceptor noticed as well, and quickly determined that no, the bag wasn’t leaking, the catheter itself was leaking and “we” would change it. She asked which of us wanted to do it. Without thinking, I asked in alarm, “Wait, we can do that? We haven’t learned that yet!” She glared at me and said, “Well, I certainly hope you can do it Rachel! You better be able to do that.” I fell silent. She asked again, who wanted to do it. Suddenly, without my permission, a spirit possessed me and I somehow volunteered myself to change the catheter. Who me?? Yes, me. In a dream state, I listened to her instructions and prepared the sterile field. With 10 pairs of eyes (or 11 pairs, counting our patient) watching my every move, I tried to remain calm. I don’t remember much about the process, except that I went through 2 catheters instead of one because my preceptor forgot to tell me when to apply the Betadine the first time, but other than that, it went without a hitch. Luckily for me, this lady was no stranger to catheters and her urethra make an easy target. I was in shock at the end of this, “Oh…wow, that was me! I did that!” But the best part was realizing that in many ways, this wasn’t so different from working in assisted living. I helped someone. As (student) nurses, we made her day better. She had been lying in her own urine, and now she was clean and dry with a new catheter and a freshly dressed pressure sore. I may have felt a little too much sympathy for her condition, but I was also able to walk away feeling like we made a difference. So, that was two weeks ago.

This past week, we were paired in smaller groups with patients. Our patient was an older, emaciated woman, with a trach. When I first saw her, all I could focus on was the plethora of tubes and indwelling lines coming out of her body. Her face was caked with residual sleep, and her mouth needing to be swabbed badly. She looked uncomfortable. I cannot imagine being unable to get out of bed in the morning, stretch deeply, and relieve myself…perhaps splashing water on my face as well. Yet here she was, waiting for the assistance of someone else before she could “do” any of those things. Making matters worse, she didn’t understand that she couldn’t get up and go to bathroom, despite us explaining it to her multiple times. (What do you say? “I am sorry, but here’s a lovely bed pan for you to use instead? Yes, I know you feel like you have energy to walk to the bathroom, but you see, there are all these tubes you are attached to, and they are breathing for you…”) She tried to communicate via lip-reading, but really, she was much better at reading our lips than we were at reading hers. Understandably, this frustrated her immensely. Not knowing what else to do, another student and I started the bed bath. Washing her face, I watched a completely different emotion take over. From consternation and vulnerability her expression melted into total peace and relaxation. Her eyes closed, and her lips spread into a serene smile. It was amazing to watch, and my own body relaxed as well. I swabbed her lips, and suctioned her mouth. We worked our way slowly down her body, warming the water periodically, assessing her skin all the way down. It was a lovely experience, knowing that we were providing palliative care when there really wasn’t much else we could do. The day was draining. Our patient didn’t receive visitors and it was hard to see her all alone, knowing that no one came to see her. Her condition was acute, but not without a fighting chance of survival. Yet, I couldn’t help but wonder to myself whether she felt like she had much to live for. A week later, I was still pondering this conundrum until I realized something quite simple. It is not my place to wonder for her, or to make that decision. My role is to make her day, the moments that I am with her, a little better. I am there to ease her discomfort, ensure that she is not in pain, and fulfill her basic needs. I am there for comfort and healing, which is why I went into this profession. Remembering this, I leave the hospital feeling tired but satiated, as if I have just eaten a big bowl of steaming soup.

*Name changed.

 
 

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Impossible Goodbyes

Quote from the amazing woman who knit this for me: "Every time you use this dish cloth it will make you think, 'Gosh darn that old woman, she made me wash the dishes!'"

I felt like I was breaking up with my residents last night. And I had to do it 10+ times.

It was incredibly difficult to leave these people, knowing that it is likely I will never see them ever again. How do you leave someone who you have known so intimately? I am not an expert in this. Never before have I said “goodbye” to someone who I have cared for. Frankly, I have never cared for someone in this capacity. It is not a parental role, nor is it the role of a babysitter: God no. What is it?

As a care manager, I learned the needs of all of my residents so that I could (hopefully) anticipate them intuitively, preserving as much independence as possible in every individual. I have discovered that as a grandchild, you know your grandparents on one kind of intimate level, familiar with their personality, their love, and compassion. But peel away the outermost layers of this metaphorical human-shaped onion and you may encounter closely guarded hopes and fears, basic needs, and sometimes, the most fundamentally raw emotions. You help them do the things (what we call “activities of daily living” or ADL’s) that we, as young people, don’t actively think about because they are as natural and easy to do as breathing. As one grows older, these ADL’s become monumental tasks, oftentimes requiring assistance to complete, which may be accepted with initial reluctance and insecurity. Accepting assistance establishes a degree of dependence on another human being, from which a relationship buds, that is unique and completely unreplicable. Bathing a person, picking out clothes and dressing, assisting with bathroom needs; these are the tasks that we don’t often think about doing, but in assisting someone else, they became simple pleasures for me.

Initially, I pursued my Nursing Assistant Certification for the purpose of meeting a nursing school’s requirements, which turned out to be a school that I will not attend. Since then, however, I have discovered a plethora of reasons why this was one of the best decisions that I have ever made. First and foremost, I feel calmness in my soul. As silly as it may sound, I was seeking a place for my passions to land in the year post-college and I hadn’t quite hit it on the head. I found many things that I was interested in, but not the thing that scratched my itch in exactly the right way. Caring for people does that for me. More specifically, helping people heal tickles my pickle.

Furthermore, without this experience, I wouldn’t have these memories to look back upon when I dive headfirst into an intensely rigorous accelerated nursing program. I already imagine that as my mind’s personal helicopter whirls and twirls amid all the new and foreign clinical concepts, every once in a while it will settle peacefully on the landing pad of memories formed by working with my first patients: my residents. And as this happens, I can only hope that a reflexive nurturing quality of care will take over, and I will be a good clinician. Yesterday, I was able to hear (10 or more times) that I was a good caretaker, and I will be an excellent nurse. It felt amazing. (Tangent: However, today when I got my blood drawn, I tried to watch the needle go into my skin, and imagined myself doing the same things to another person, and I felt queasy and light headed.) All I can say is this: Oh boy, I really hope my residents are right. :-s

Yesterday, as I gave out my picture frames, my residents said a number of things to me that made me want to cry and smile all at once. My most independent resident said one thing that made my internal voice squeal, “This is something to be remembered! Scribble it on your inner whiteboard!”

She is graceful and tall and she knits a multitude of sweet dish cloths like a one-person factory. I hope I never forget her strong featured face as she looked at me and said simply, “Wherever you go, and whatever you do, think of us once in a while and we’ll think of you constantly.”

I am sure that I will think of all my residents more than “once in awhile” (just as I am certain they will not think of me as often as “constantly”). But it gives me great peace in knowing that even when I struggled, I was doing a decent job. My best is good enough and these people, who know me well, truly believe in me. I feel a deep-seated consciousness that as I progress, somewhere, somehow, my residents will be watching over me.

 
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Posted by on March 16, 2010 in Healing Spoonful

 

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