Thursday, December 31, 2009

Saying Goodbye to 2009

It's been quite a year for many people, and 2009 is now in it's waning hours. As the year ends, so many people seem poised on the brink of change and flux, ready for new adventures, letting go of the old and welcoming the new. It's a time for reflection, self-evaluation, congratulations, repentance, and embracing of change. I've always loved the New Year and the opportunity to start again.

For myself, it has been a year of momentous change, uprooting, letting go, and moving on. In 2009, I lost at least 15 or 20 pounds, continued to live with chronic pain and Multiple Chemical Sensitivity (MCS), quit my job as a Public Health Nurse, sold our house, sold or gave away most of our possessions, bought a mobile home, and left our beloved Western Massachusetts for parts unknown. What a ride!

As 2010 begins, Mary and I find ourselves in Americus, Georgia, making our way down the East Coast of the US, ready to turn West and continue along the Gulf of Mexico in search of a new life, community, improved health, and an opportunity to "reboot" our lives as we enter our third decade of marriage.

In terms of my health, I am not sure where to turn next. My chronic pain continues unabated, and my hope is that living in a warmer, sunnier climate will ease the pain that challenges my body most every day (but at least not every moment!).

In terms of MCS, we must make a concerted effort to avoid exposures to fragrances and chemicals that make us sick, and this is one of our greatest challenges from day to day. Nasty and toxic chemicals are everywhere---in homes, businesses, and even as we walk down the street. Laundry detergent, perfumes, scented candles, emissions, cleaners---we are surrounded and under siege.

When it comes to work and career, my identity as a nurse remains strong, but my resolve to work as a nurse in the future is wavering. I will most likely seek employment as a nurse again, but will also continue to explore other options---such as health and wellness coaching---as I take time to contemplate what I have already dubbed "my occupational navel".

The world itself is also in flux. Some form of health care reform is on the table here in the US, even though it has been watered down to some shadowy semblance of what many of us would like to see. War continues unabated, and injustice and violence run rampant in many countries as the world economy sputters and burps.

Still, people of good will can be found everywhere one turns. Service, compassion, volunteerism, community, sustainability and peace are common, and more and more people are dedicating their lives and livelihoods to causes in which they believe. Suffering can be found anywhere one looks for it, but responses to that suffering can also be seen, and it is in the response to suffering that we see hope for the future. In the mainstream media, bad news can dominate and overwhelm, but the alternative (and mainstream) media can also offer hope, with reports of amazing work being done to assuage the disparities and injustices of the world.

So, I ask myself how I can assuage the suffering of others in this New Year, how I can give back and improve the world in which I live. At the same time, I ask how I can continue to heal myself and improve my own well-being, since I can only help others if I come from a healed and healthy place. Sure, there are wounded activists out there who try to save the world while ignoring their own needs, but I am a true believer in the notion that one can only help others if one is willing to help---and heal---one's self.

With the New Year comes new opportunities for growth, self-reflection, self-improvement, service, positive change, community, and all good things. My desire is for 2010 to be the dawn of a new life for myself and my wife, and also a year in which every person moves closer towards their greatest desires and their own optimal well-being. Every day is a new chance to start again, and my hope is that many people will achieve their dreams, live in peace, live healthier and more prosperous lives, and take time to work towards a better world. Yes, it's a troubled world, but it's the only one we have, so may 2010 bring us closer to the vision of a world in balance and at peace.

Happy New Year to all, and may all brings be free from suffering.

Monday, December 28, 2009

Inspiring Blogs for People with Chronic Illness

I am humbled and happy to report that Digital Doorway has been included in a list of 100 inspiring blogs for people affected by chronic illness. My gratitude to the generous people at MedicalFuture.

Friday, December 25, 2009

Christmas Thoughts

On this day that's so important to so many, I pause to give thanks for family, friends, my health, my wife, my son and his new wife, our elderly but healthy dog, and the opportunity that I currently have to take a break from working in order to reevaluate and reboot my life.

On a personal level, this has been a year of great change, upheaval, letting go, and moving on. I plan to make 2010 a fantastic year of growth, improved health and unparalleled happiness, and I wish everyone the same as this year comes to a close and a new one begins.

May all beings be free from suffering, and may we all continue on the path of global and personal healing.

Thursday, December 24, 2009

A Merry Christmas Change of Shift

Here's a link to the newest edition of Change of Shift, the nurse blog carnival that's a gift that keeps on giving every month of the year. I haven't contributed for months, and I plan to change that in 2010. Thanks to Kim and everyone at CoS who contributes so consistently! Happy Holidays to all!

Monday, December 21, 2009

Digital Doorway On List of Top 50 Nursing Blogs

I am pleased to report that Digital Doorway has been included on the Nursense list of the top 50 nursing blogs on the internet.

My humble thanks for this wonderful honor, and Happy Holidays to the folks at Nursense.

Saturday, December 19, 2009

Of Nursing and Soulful Employment

At this point in mid-life, as my wife and I take a break from working and travel the country, I am giving a great deal of thought to my career, or what I think my career should be. Nursing is certainly the career track upon which I have been treading since 1996, and it is indeed a viable, flexible and (sometimes) attractive way to earn a living. While I have never worked in a hospital (which some nurses deem an irresponsible act of professional suicide), I have enjoyed many positions in the outpatient world, namely hospice, community health centers, home care, case management, and public health.

After almost fourteen years as a nurse, I am questioning what the next chapter will look like. Will I work with Latinos in New Mexico, Native Americans in Arizona, the rural poor, the affluent and sickly? Or will I find a way to make a living as a health and wellness coach, eschewing the world of nursing altogether? I have great desire to be an entrepreneur, but the world of self-employment is not always what it's cracked up to be. However, with my wife as my business manager, I may stand a chance at significant success!

This time of travel and self-reflection is helping me to disengage mentally from the world of work and employment, allowing me a golden opportunity to dig deeply and decide how I want to spend my time and earn a living. There are so many roads from which to choose, and nursing is, as a matter of course, one of the easiest paths to trod.

Of course, when push comes to shove and money needs to be made, a job as a nurse will certainly pay the bills, but only time will tell if there is indeed a nursing job out there that can truly feed my soul, for that is what I have decided work should really do.

Nursing can be a soulful occupation, and if I can work as a nurse and be fulfilled in that endeavor, then I'll be ready to sign on the dotted line. Til then, I will continue to examine my occupational navel and unravel the riddle of figuring out just what will make my vocation more than simply a means to a financial end.

Monday, November 30, 2009

The Moon and The Lake

Deep in the hills of southern Virginia, I stand on a small dock that rests on the still waters of a small lake adjacent to the campground where we are currently staying during this phase of our journey around the country.

The water of the lake is absolutely still, the air is chilly, and the full moon itself seems to move quickly through the sky above me, even though I know that it's the low-flying clouds that are actually moving, not the moon.

I picture the clouds as representations of the thoughts that constantly swirl through my head, and the stillness of the surface of the lake represents the nature of my mind, or how I am told my mind should be. Those clouds are simply brief interruptions of the clarity of the sky above them, and the sky remains as vast and deep and unperturbed as always, no matter how many clouds pass over its wide-eyed screen.

As the clouds pass overhead, they are very clearly reflected on the surface of the dark lake, as in the placid face of the large white moon. The reflections of the clouds are no more real than my many disturbing thoughts, but I seem unable to distinguish between the real and the unreal.

I know the reflections in the water are simply reflections, just as I should know that my thoughts are only thoughts and nothing more. Why do my thoughts so easily disturb my peace of mind? Why do the clouds that pass across the surface of my inner lake so quickly cause ripples and waves that easily throw me off course?

My undisciplined mind yearns for clarity, its surface so frequently disturbed from within and without. That lake, so calmly reflecting the moon and clouds above it, knows nothing of worry, of anxiety, of rumination. Would that my mind could learn the lesson taught by the stillness of that clear, cold lake and the vast sky above it.

Thursday, November 26, 2009


Dear Readers,

On this day of Thanksgiving, I am sending my heartfelt wishes for a wonderful day, whether you are with friends, family, at work, at play, or on the road. This is indeed a day to reflect on our blessings, and I will certainly take the opportunity to reflect on the many things for which I am personally grateful.

We are currently in southern Maryland, making our way south on our round-the-country journey. I know that Digital Doorway has been somewhat quiet of late, and I hope to bring more life here as our journey continues on.

Thank you for stopping by, and many blessings on you and yours, now and always.

Tuesday, November 17, 2009

Recovering From the Shock Of Suicide

Losing a close friend to suicide is like having the fabric of one's life torn open without warning. It is a shocking loss, a bitter and horrific loss. What could be more disruptive to the normal trajectory of life?

Having lost a friend to homicide (by police) in 2001 and now a friend to suicide in 2009, there is a continuum of grief and mourning along which I continue to travel. Ironically, it is only quite recently that I feel I've made significant progress in accepting and coming to terms with my friend's 2001 murder, so perhaps I have been handed this newest challenge in order to further sharpen my skills of recovery.

Suicide, that most self-centered of acts, removes a person's physical presence in a sudden, unexpected and brutal way. This self-inflicted disappearance sends ripples---or perhaps shockwaves---throughout multiple communities and layers of relationships, and each individual impacted by the news must grapple with their own messy constellation of feelings, be it guilt, remorse, anger, disbelief, shock, or any number of normal reactions in reaction to an abnormal circumstance.

For myself, I question what I said or didn't say, what I did or didn't do, the invitations not offered, the times I gave up or pulled back. I used the word "brutal" in the previous paragraph for a reason, in order to more fully illustrate the painful significance of a suicide in relation to those left behind. It is indeed a brutal reality when the phone rings and the news that a close friend has taken his own life is communicated across the ethers. It is gut-wrenching and maddeningly brutal, a harsh slap in the face, an iron fist to the solar plexus. It is exhausting.

For those of us left in the wake of suicide, it is a process of recovery and acceptance, and we do what we can to make it through the days in the wake of unwelcome news that painfully and irrevocably changes our lives.

Saturday, November 14, 2009

The Dance of Sudden Loss and Grief

Today I am reeling from devastating news of the sudden and tragic death of a very dear friend. Death frequently seems to visit when least expected, and this lack of ability to prepare for loss is one of the factors that can make it so difficult to cope when death pays a call.

Eight years ago, another dear friend died unjustly at the hands of the police, followed by the death of my great-aunt, my beloved dog, and my step-father. Digesting this recent history, one of my personal themes for the majority of the last decade has been recovery from grief and traumatic loss.

Now with another friend suddenly gone, the list of losses suffered over this last decade has lengthened, and my personal resiliency vis-a-vis grief and loss is challenged once again. In one respect, I am at a loss for words, but on the other hand I have a deep need to reach out across the ethers and ask for support and prayers.

Death has visited our house, and we dance the dance of grief once again.

Wednesday, November 11, 2009

What Next?

Being on the road, not working and simply traveling, I wonder what will become of my identity as a nurse and a health care provider. While I still introduce myself as a nurse, I begin to wonder to myself just what that means exactly. Am I a nurse because I think like one? Is it the tattered license in my wallet? Or is it the fourteen years of experience that simply make it so? Is my "nurseness" still intact when on sabbatical, or does it take a back seat to my basic humanity?

These days of living on the road with my wife and dog as peripatetic travelers is beginning to challenge even my own self-perception of who I really am. An enormous part of my identity has been wrapped up in being a nurse for more than a decade now, and as we embrace the open road and all it has to offer, that very identity is shaken to the core. Still, it's a comfort to have both a vocation and a calling that serve both my sense of identity and my ability to be economically stable.

For now, we travel the highways and byways of the United States, and I will eventually christen my work as a health and wellness coach, taking my work as a nurse to a new level of novelty and service. Til then, my "nurseness" is simply a state of mind!

Friday, November 06, 2009

When Calamity Strikes

Well, experience demonstrates again and again that even when one is "off duty" as a nurse or medical professional, one's training can kick into gear at any moment.

Today, I was placidly sitting in my cousin's living room with my laptop. Knowing that there were several roofers crawling around above our heads, some modicum of loud sounds was not unexpected. However, when a series of crashes occurred in a space of several seconds, I looked up to witness a body falling rapidly through space towards the ground past the window opposite the couch where I was seated.

With my wife yelling for help and my cousin calling 911, we ran to the back yard to find a roofer who had fallen from the second floor level, bouncing off of the roof of the dining room and the deck before landing on the ground.

It was quite a scene, and it was indeed gratifying to be able to quickly assess his injuries and level of consciousness, cajole him not to move a muscle, and determine that he could safely wait for the ambulance to arrive.

Luckily, he sustained no major injuries and was treated and released from the emergency room within several hours. Every time I respond to an event of this kind (like car accidents), I realize that I should really undergo a refresher course in First Aid and emergency medical response. However, my nursing assessment skills did indeed come in handy, and I was happy to be of service, however limited my abilities.

Photo by Mary Rives

Sunday, November 01, 2009

The Peripatetic Nurse is on the Road

Dear Readers,

My wife and I are now on the road, making our way down the East Coast towards the warmer weather. Our travel blog, Mary's and Keith's Excellent Adventure, is becoming increasingly robust with photos, videos and tales from the road.

Our new lifestyle poses many exciting challenges and novel experiences, one of which is health care. While we still have health insurance from my old job until November 30th, the next step will be securing (at least) minimal catastrophic coverage from that date forward, and then making sure we take very good care of ourselves while we travel. Good nutrition, exercise, high quality supplements and a plethora of fresh air are undoubtedly part of our personal health prescription.

I will be reporting on our health challenges and successes along the way, and hope to talk to other full-time RV'ers to see how they handle health on the road (although many full-timers are retired and relatively secure with Medicare coverage).

Stay tuned, and please visit our travel blog for further updates!

Thursday, October 22, 2009

Saying "Adios" to My Hispanic Mother

Yesterday, I visited an elderly woman for whom I served as visiting nurse about a decade ago, and with whom I have maintained a sweet connection for years. We have kept in touch throughout the years, and although I no longer work in the city where she lives (about 45 minutes south), we talk periodically and I visit when I can. I had already explained to her that my wife and I have sold our house and are going traveling for the foreseeable future, and the need for a last visit was too strong to ignore or postpone until it was too late.

A Puerto Rican woman about the same age as my mother, she likes to joke that she is my "Hispanic Mother", and for all intents and purposes, it's true. Obese and disabled, she keeps more than a dozen birds in various cages in her small apartment, and several of them are regularly perched on her shoulder (or on top of her head), eating sunflower seeds right from her lips. Her apartment is filled with knick-knacks (some of which I am guilty of giving her, I must admit), and our visit was punctuated with screams and applause as "The Price is Right" played loudly on the TV.

Although maintaining long-term relationships with former patients can be tricky in terms of personal boundaries, this friendship has been consistently special and it has only been occasionally burdensome to maintain. Our connection is intimate and sweet, and there was just no way I could leave the area without a proper "adios".

After an hour visit, we realized that it was time to say goodbye, and we hugged and kissed each other on the cheek repeatedly. After our second hug, both of our faces were wet with tears, and she held both my hands in hers as she gave me her abundant blessings for a long life, a joyful and wonderful journey with my wife and my dog, and she thanked me from the bottom of her heart for my friendship over the years.

I left the stuffy apartment and emerged into the bright October day, stopping under a resplendent tree bedecked in autumnal yellow. My heart was filled with love, tears streaming down my face, and I gave thanks for the heartfelt and soulful connections that being a nurse has provided me over the years.

As we prepare to leave this area where we've lived for seventeen years, there will be more tearful goodbyes. My "Hispanic Mother" is one who evoked very deep and bittersweet tears, and I have no doubt there will be more to come as we draw nearer to our very imminent departure.

Wednesday, October 14, 2009

Taking Leave...Again

Tomorrow is my last day at work. I am leaving behind the local health department, the furor over H1N1, my coworkers, my position as a Public Health Nurse, and the network of professional colleagues that I have created over the last 12 months. My work as a nurse is coming to a temporary close as my wife and I prepare to launch on a cross-country adventure with no fixed end date and the open road ahead of us.

I am so impressed with my public health colleagues, the local school department, and all of the people with whom I have been so lucky to collaborate. H1N1 has been a rallying cry for many disparate entities in towns, schools, and cities across the country and around the world, and the collaborative nature of many of these relationships underscores how professionals from very different areas of expertise and education can work together for a common cause. 

I am excited and nervous about how this next stage of life will develop as my wife and I take our Laughter Yoga business on the road and I launch a new professional pursuit as a health and wellness coach. Please stay tuned for updates as I build my new website and officially begin work as a coach, while Digital Doorway continues to be a place where I share my ideas, adventures and thoughts along the way.

Thursday, October 08, 2009

Adventure Afoot

Dear Readers,

For those of you not yet aware, my wife and I are in the midst of radical change in our lives. In six days, we will quit our jobs, leave our New England home of seventeen years, and begin traveling the country via RV in search of adventure and a new home.

This journey will take us down the East Coast via Connecticut, New York, Pennsylvania, New Jersey, the DC are, Virginia, the Carolinas, Georgia, Tennessee and Florida, and then across the Gulf Coast through Mississippi, Louisiana and Texas. We will then proceed through the southwest US and up the West Coast and beyond.

Along the way, we will be visiting friends, family and intentional communities, always with an eye for a place that feels like home. If you have a suggestion for a place to visit, please let me know!

We will be posting about our experiences on our new travel blog, Mary and Keith's Excellent Adventure, so please consider visiting and becoming a follower of our blog (as well as this one, of course!).

On the road, we will be looking for opportunities to offer Laughter Yoga to workplaces, hospitals, senior centers, cancer centers---and group of people who would like to learn how to laugh for no reason! Our website, Laughter Incorporated, explains Laughter Yoga in detail, and also outlines the services that we offer. Your profesional referrals are welcome, and if we are coming to your town, we just might offer a Laughter Yoga session to you and your friends for a modest fee!

In addition, I will soon be launching a new business as a Health and Wellness Coach, so please stay tuned for an announcement about this exciting development in my professional life.

Thanks for tuning in, and please stay connected with us via Digital Doorway, Keith and Mary's Excellent Adventure, Laughter Incorporated, and last but not least, The Adventures of Bob the Nurse.

Be well and happy!

Friday, October 02, 2009

H1N1: Here for the Duration

As the flu season heats up and the weather cools down, the media are beginning to more frequently report deaths from H1N1 influenza. Although overall influenza-related deaths are still within the expected range for this time of year, there have been 60 pediatric deaths from H1N1 reported to the CDC since April, including 11 this week, and hospitalization rates are indeed higher than normal.

In the public health arena, many of us are wondering just how the public will react to these reports and the growing numbers of children who are ill or dead. While it's true that an average of 36,000 Americans die every year from the flu, the majority of these individuals are usually elderly or otherwise compromised, and if the number of children who die continues to climb, anxiety and fear will rise proportionately.

The government claims that the H1N1 vaccine is safe, and they are urging every pregnant woman and individual between the ages of 6 months and 24 years to be immunized, among others. I have heard projections that only 20% of eligible Americans may actually elect to receive the new vaccine, but I am not certain how accurate that estimate is. When the vaccine begins rolling out to local health departments, schools, medical providers and municipalities next week, it remains to be seen how the public will respond to well-publicized offers of mass vaccination against a novel disease.

Of course, at times like these, the public can react in many ways. A small percentage feel that the government has overreacted, blowing the risks of H1N1 out of proportion. While this could potentially be the case when the book is finally closed on H1N1, there would be even greater consternation if the government underreacted and millions needlessly died. Hurricane Katrina taught a mean lesson when it comes to government negligence, and it appears that the Obama Administration does not want to repeat such a disastrous mistake at a time when the stakes are so high.

Meanwhile, other segments of the population worry and fret over every sneeze and cough, while others simply wait to be told what to do. Most, I feel, are simply watching the headlines, testing the winds with a tentative finger, and biding their time as the situation develops and changes.

So, the reports of deaths continue to roll in, cases are diagnosed daily, and the entire infrastructure of the global community itself is potentially at risk. You can wager any amount of money that massive contingency plans have been made by most every government on earth, contingency plans that focus on how crucial infrastructures can continue to function in the face of widespread illness.

Plans for continuity of operations are now being drafted by hospitals, newspapers, factories, schools, and many companies and organizations that realize the potential for massive disruption if widespread illness should visit their particular organization. Just imagine if you run a high school. What would you do if 50% of your teachers were ill, or 75% of food workers, custodians or bus drivers called in sick? Woe to those who leave their plans undrafted.

The wave of H1N1 is indeed beginning to swell, and just how powerful and far-reaching that swell will become remains to be seen. To be sure, it will be a historic flu season in many ways. Whole economies may be impacted greatly by the disease, schools may be closed, factories may lay idle, and governmental and non-governmental organizations may be crippled by absenteeism and illness. And when it comes to the children, we can only hope that the number of deaths is kept to a bare minimum in the larger scheme of things.

Wednesday, September 30, 2009

Facing the Unknown

The health care debate seems to be full of unknowns these days. As the arguments over health care reform heat up to the boiling point, the notion of a government-run program raises the hackles of so many people across the spectrum, and cries of socialism are heard across the land. Will our care be rationed? Will grandma be left to die when a bureaucrat decides that she has reached her life expectancy and her surgery is not cost effective based on her age? Misrepresentation and misinformation abounds.

Meanwhile, H1N1 challenges the public health infrastructure, and the availability and distribution of the vaccine poses questions that still cannot be fully answered. And as the manufacturing of that new vaccine is ramped up, seasonal flu vaccine distribution has been slowed to a veritable trickle, confounding the plans of even the most earnest local health department.

Speaking of H1N1, studies now show that many pregnant women and others eligible for the H1N1 vaccine will refuse to receive it, leaving public health officials wondering just who will want it, anyway? In our local circles, many of us are asking the following question: "If we throw an H1N1 party, will anyone come?"

Wednesday, September 23, 2009

A Replacement Cometh

Today was the day when we interviewed the four top candidates to replace me in my position as Public Health Nurse. Without disclosing anything specific about the interviews or the interviewees themselves, it was a relief to realize that, yes, there are a number of qualified candidates who are interested in taking my place and assuming all of my responsibilities. Even more encouraging, our #1 choice is available to start on October 1st, which would afford a two-week overlap before I gracefully exit, stage left.

In prior blog posts (see "Stirrings of Nursely Guilt"), I have discussed the feeling of being indispensable as a nurse, carrying my nursing positions like crosses that I alone can bear. That's complete hogwash, of course, and I continue to process the emotions that lay beneath the nursely guilt complex.

Leaving my current position---at a time when the public health infrastructure is facing its greatest challenge in a generation---is truly a test of my personal resolve, and the guilt underscores for me the fact that I truly want to leave my position in qualified and well-prepared hands.

Today, it seems that the capable and qualified hands for which I have been waiting may well be ready to relieve me of my occupational burden (and guilt!), and I am only now beginning to see glimmers of light at the end of the tunnel.

Personally, these are exciting times as my wife and I ready ourselves for the cross-country trip of a lifetime. Wresting ourselves from our occupational shackles is one of the final acts that we must mindfully commit prior to stepping off of the precipice into the Great Unknown. And knowing that we may very well have found the person to whom I can pass the public health torch is a feeling of relief beyond measure. Now, as I wait to hear that the offer of employment has been accepted, I dare not to hold my breath........

Monday, September 21, 2009

Most Famous Nurses in History

Dear Readers,

Here is a link to a very interesting and informative post on the 25 most famous nurses in history, including a separate section on famous fictional nurses. Of course, they have not yet included Bob the Nurse on such lists, but I intend to make sure that Bob does indeed go down in nursing history!

Sunday, September 20, 2009

Finding a Successor

This week, we will interview four potential successors, intrepid nurses who are willing (and hopefully able) to pick up where I leave off on October 15th. The one who is chosen to take my place will inherit my office, my files, my newly written Public Health Nurse training manual, my many responsibilities, and the certainty that this flu season will be a doozy.

In preparation for my departure, I will continue to write the training manual, purge and organize files, order supplies, and administer as many flu shots as I can before my successor takes over. Now, the problem is that production and distribution of the seasonal flu vaccine is now slowing to a trickle as manufacturers try to cope with the ramped up need for H1N1 vaccine. So, plan as we may, how can we hold successful and far-reaching flu clinics if the flu vaccine is in short supply? Woe to the public health nurse who wants to be ahead of the 8-ball for a change.

So, we prepare, we strategize, and we hope---with multiple fingers crossed---that one of the interviewees is indeed intrepid, ready, willing, and able to pick up the torch and run with it into the crashing waves of flu season.

Friday, September 18, 2009

Change of Shift at Medic 999

The newest edition of Change of Shift, the famous nursing blog carnival, is up and ready for visiting at Medic 999. Pay a visit!

Monday, September 14, 2009

H1N1: Many Questions and Stormy Days Ahead

The questions about H1N1 are coming fast and furious now, and I often don't know what to say.

Seniors feel slighted because they're lowest on the priority list for the new H1N1 vaccine. Middle-aged people who are otherwise healthy who would like the vaccine notice that they do not meet the criteria for being in the first wave of recipients, if at all. There are the many health care workers who usually don't receive a flu vaccine and are reluctant to get the H1N1 vaccine, even if it means protecting their patients from illness. Meanwhile, pregnant women are afraid to receive this newly formulated vaccine, even though they are top priority for receiving it in order to protect their gestating children, and parents of school age children are also afraid. And then there's the conspiracy theorists who feel it's all a government ploy to poison, sicken, and subjugate us.

What's an earnest Public Health Nurse to do, anyway?

The concerns, the worries, the misgivings, the fears, the suspicions---they are all rising to the surface as the flu season kicks into gear. There is certainly confusing information out there, and some of it even seems contradictory. We can rest assured that many media outlets will undoubtedly get it wrong along the way, further adding to the confusion that so many people feel.

So I answer calls, assuage fears, refer people to the most reliable websites about H1N1, and I cross my fingers that we find a qualified replacement for me before I leave my position on October 15th. It's a wild influenza world out there, and something tells me the weather's about to get rougher.

Friday, September 11, 2009

The Nurse as Sisyphus

As I march headlong towards my last day at work as a public health nurse, I am reminded again and again how the work of a nurse often seems Sisyphean in nature. Sisyphus, you may recall, is the poor downtrodden soul who was doomed by Hades to spend the rest of his days pushing a boulder up an impossibly steep hill, only to have it roll back down at the end of the day, making his day's toil utterly useless.

Now, I am not meaning to say that my work as a nurse is thankless, pointless and unrewarding. Far from it. But the Sisyphean aspect of nursing resides in the notion that whatever we do, however we do it, it never seems to be enough. Nursing of all kinds demands attention to detail, amazing amounts of paperwork, vast stores of patience (and some patients, as well, of course), and a willingness to consistently give more than you may have been ready or able to give. In my view, nursing is often the work of the willingly codependent, those of us willing, able and ready to go above and beyond again and again, even when it is against our better judgment, compromises our health, and subjects us to the vicissitudes of stress-induced illness.

As a nurse, I have consistently found myself in positions wherein I felt indispensable, the repository of information or knowledge that is, a) difficult to pass on and, b) incredibly important. Whether it be patient care or public health management, taking my leave of a nursing position is so often fraught with anxiety, hard work, and the knowledge that not everything that I know can be clearly communicated to my successor.

Winding up my work as a public health nurse, I am hard pressed to write down the endless details that constitute my position and my work from day to day. When I took this position, I was given five sheets of paper with cryptic instructions, three hours of rushed training, and an office and files that were in dire need of organization. I inherited a multifaceted position that was poorly explained and passed on in a manner that created the steepest possible learning curve as I dipped my toes in the waters of local public health.

Now, preparing for my successor (who has yet to be identified despite my having given a very generous three months' notice some two months ago), I am writing a training manual, organizing files, streamlining processes, and preparing for what I hope will be two full weeks of training for a position that is simultaneously fascinating and maddening.

As my wife and I prepare to step into the unknown in our personal lives, I am hoping to create as few unknowns as possible for the intrepid soul who picks up where I leave off at the health department. And with H1N1 breathing down our necks, that will not be a small undertaking for myself or the next in line.

So, I struggle to create a seamless transition, knowing full well that some "t" will be left uncrossed, some "i" undotted, and some loose end will inevitable be left untied. Did I say that this undertaking was Sisyphean? It may very well seem that way, but on October 15th when I leave that office behind, my shoulder will no longer bear the burden of the boulder being pushed up that hill, and I, for one, will rejoice at the freedom that the loss of that burden will engender.

Wednesday, September 09, 2009

Can Obama Do It?

Even though I rarely listen to the radio anymore and no longer have TV, we tuned into President Obama's health care speech this evening, and I felt stirrings of hope as his words flowed through the airwaves.

Not having examined the speech closely, my hope is tinged with a hint of cynicism at the ways of Washington, but with the post-humous words of Ted Kennedy spurring us on, I feel that perhaps the reform we have all been waiting for may actually come to pass.

Even as the debate rages on, millions of American children still live without health insurance, the unemployed and underemployed seek primary care in emergency rooms, and the self-employed struggle to find coverage that doesn't break the bank.

Cries of socialism abound, but the President reminds us that Medicare itself was derided as being tantamount to socialism back in the day, and that "sacred trust" is now a promise that no American would ever wish to see broken.

I hold out hope that we will see comprehensive health care reform in this decade, and that my grandchildren will grow up in a country where they will never need to choose between medicine and groceries.

Health care reform? Socialism? If every American can obtain affordable coverage and no one has to go without, then I don't care what we call it. Can Obama do it? Only time will tell.

Monday, September 07, 2009

Stirrings of Nursely Guilt

Well, in a mere 6 weeks I will be saying goodbye to my work as a Public Health Nurse and hitting the open road with my wife and dog (see our new blog for details).

So, what does it mean to eschew the trappings of the workaday world and leave the workforce, at least temporarily? What does it say about someone who works in public health and chooses to step out of that role just as H1N1 begins to rear its wintry head in our very direction? How selfish am I?

As I prepare to quit my job, leave the workaday world, pack up our cares and woes, gear up the RV and launch ourselves onto the highways and byways of America, I feel stirrings of nursely guilt that I am abandoning ship just as my country needs me the most.

Sure, we could have changed our plans. We could have chosen to spend yet another frosty winter in New England, slogging through the snow to save humanity. But my wife and I are making another choice. We are choosing to catapult our lives forward in a radical way, and doing something this radical has its price, and one price that I am currently paying is the feeling that I am breaking ranks when my services are most urgently needed.

Now, I am not one to think that no one else can do my job. There are plenty of capable nurses out there, and two of them are interviewing for my position in a week or so. Still, taking leave of my job at this historical time does indeed put extra stress on our local public health infrastructure, and I am concerned that my replacement will completely miss the frying pan as she or he falls directly into the fire of H1N1 and flu season. (Oh, the guilt.)

Still, I am thankful and appreciative that my boss is so evolved and has given me her (understandably reluctant) blessings to go on my merry way. And perhaps my worries are for nothing. Will H1N1 fall flat on its face? Will the massive vaccination campaign never materialize? Will this public health juggernaut never leave the launchpad? I actually feel that the H1N1 horse has already left the gate and we are rushing headlong into what will be a pretty intense flu season, made infinitely more complicated by twin vaccination campaigns (for seasonal flu and H1N1).

May my successor accept this challenge with grace and equanimity, and may I take leave of my position without guilt or remorse. The helper and healer within me cringes at ever shirking my nursely responsibilities, and leaving this job at this time in history is one of the hardest professional decisions I have ever made.

Saturday, August 29, 2009

100 Blog Posts To Read Before Going to Nursing School

I am pleased to report that a post from Digital Doorway has been included in a list of 100 blog posts to read before going to nursing school. The list can be accessed by clicking here, and I am honored to have been included in the sub-section entitled "Getting Through School".

Friday, August 28, 2009

H1N1, Fear, and the Need for Calm Vigilance

As the public health infrastructure gears up for the coming flu season and the potential resurgence of H1N1 from its summer lassitude, those of us on the front lines of that infrastructure are left with many questions.

First, as we await the first shipments of seasonal flu vaccine (which should begin arriving soon), we are faced with questions from the public about whether they are eligible for the seasonal flu vaccine, whether or not they will be able to receive the H1N1 vaccine, and how they might protect themselves against these strains of flu that threaten to sicken and perhaps kill thousands of people. We are also faced with the public relations nightmare of explaining the different criteria for the two vaccines, based on the fact that younger people are more susceptible to H1N1 infection, whereas the elderly more often succumb to seasonal flu. While there is some overlap between groups susceptible to both illnesses, a great deal of education will need to be done in order to allay fears and identify who will receive vaccinations.

Next, there are fears that schools, municipal offices, police and fire departments, hospitals and other critical services may be seriously curtailed or shut down if large numbers of employees become sickened with a virulent form of the flu. Just the other day, I attended a meeting with a number of local school officials, and weighty issues of great import were discussed at length as the group wrestled with contingency plans that may or may not come to fruition.

It is the fear of the unknown that drives the anxiety surrounding H1N1, and the potential for widespread illness and death does indeed stoke the fires of the media machine and the conspiracy theorists alike. For me, on the front lines of local public health, my job is to allay citizens' fears, prepare for a double-pronged mass vaccination campaign (for seasonal flu and H1N1), and meet with local officials and others in order to answer questions and suggest ways for citizens to be healthy and maintain a calm but alert vigilance.

This will be an interesting flu season, without a doubt, and it will only be hindsight that will inform us whether our preparations were thoughtful, wasteful, alarmist, or simply prudent.

Monday, August 24, 2009

Nurse Jackie Revisited

Several months ago, I watched the premier of Nurse Jackie, a new Showtime "dramedy" about a dysfunctional nurse struggling with infidelity and drug addiction, and I lambasted the show's producers and writers for choosing to portray such a flawed and troubled character who happens to be a nurse. Not having cable TV, I have not been able to watch the remainder of the season, although I hear through the grapevine that most nurses are quite unhappy with the show.

While I in no way wish nurses to only be portrayed as angels of mercy, the premier of Nurse Jackie did indeed leave a bad taste in my mouth.

Suzanne Gordon, a brilliant and insightful author for whom I have the highest esteem, has written a post about the end of the first season of the show. Ms. Gordon takes this opportunity to react to nurses like myself who have shunned Nurse Jackie out of self-righteous indignance, and she offers her own evaluation of the show, it's portrayal of 21st-century nurses, and how we as nurses may or may not be seen by the public.

I thank Ms. Gordon for her writing and her opinion, and when I do indeed watch Nurse Jackie on DVD some day, I will take her position into consideration and perhaps reevaluate the feelings that were stirred up when I first watched the premier.

Saturday, August 22, 2009

Moving Mania

Dear Readers, 

Well, amidst the heat and humidity of a New England August, we have brought our new RV home, are moving out of our house, and getting ready for the official sale and closing on August 31st.

Life is currently in hyperdrive, so blogging has by necessity taken a back seat. I can't wait to return to the keyboard and sink my writer's teeth back into the many subjects that capture my interest, among them travel, health care, nursing, Laughter Yoga, health and wellness coaching, and life in general. 

Please check back every few days, and we will hopefully be back in full blogging swing by the beginning of September!

Saturday, August 15, 2009

45 and Ready to Thrive!

Greetings, Readers of Digital Doorway! 

Today is my 45th birthday, and I am thrilled to report that I plan for this coming year to be the best year of my life so far. I had the honor and privilege of spending today with my beloved wife, my son, and my future daughter-in-law, soaking up the sun, swimming in a local pond, and sharing laughter, stories and tears as we all move into a new phase of life. As I have written so recently, my wife and I are moving out of our home and hitting the open road in an RV in order to seek out adventure wherever we find it, and our son and his new life partner are driving to Taos, New Mexico next weekend to build a life together as newlyweds. 

In this year, I will quit my job as a Public Health Nurse, continue to blog, pursue more work writing online, begin the certification process to become a Health and Wellness Coach, and strike out into the unknown with my lovely wife and our trusty old canine companion. 

Thank you for visiting Digital Doorway, and blessings to you today and always. Please stop by frequently as the adventure continues to unfold. 

Tuesday, August 11, 2009

Contemplating the Stress of Change

As my wife Mary and I prepare to radically change our lives, quit our jobs, eschew the trappings of the workaday world and hit the road to see America, I often take time to contemplate stress and how it manifests in my life.

This process of detaching ourselves from our home of eleven years, our hometown of 17 years, and all that is familiar and normal, is a process fraught with pain, pleasure, anticipation, anxiety, excitement, and plenty----plenty---of stress.

Now, don't get me wrong. I blame no one for this situation in which we find ourselves. We created this situation. We asked for it. We designed it. We will reap the rewards, cry the tears, and feel the highs and lows as we open a life chapter filled with uncertainty and adventure.

As we move through the process, stress settles in my body, curls along my spine, throbs in my neck, and disturbs my sleep. I toss and turn, I eat haphazardly, too much at one sitting---or not at all.

At work, I'm distracted, restless, frequently inefficient. I feel guilty for leaving my public health job just as flu season and H1N1 begin to heat up. Then again, I'm relieved that I'm skipping town before the infectious feces hits the proverbial fan.

After thirteen years as a nurse, I need to step away from the desk, put down the syringe, close the file cabinet, and look towards a new way of being, both professionally and personally. The stress of work has taken its toll, and it's ironic that the stress of detaching ourselves from our lives here in New England is taking its own toll on my body and mind. That said, the day will come when we weigh anchor, pull up stakes, and listen giddily as the miles roll beneath our RV's eight wheels.

I look forward to sharing the journey with you, dear Readers, here on Digital Doorway and on our new shared travel blog. It will no doubt be a wild ride, and along the way I'll be exploring and
reporting on American health care seen through the eyes of a nurse traveling the highways and the byways of America with his trusty dog and loving life partner at his side.

I hope you'll come along for the ride!

Monday, August 03, 2009

Happy Birthday to Emergiblog!

I want to take this opportunity to say Happy Fourth Birthday to Kim and her blogging brain-child Emergiblog. Kim birthed Emergiblog four years ago, and like one of my blogger colleagues said in a recent email, she is a force to be reckoned with. 

Emergiblog is on the top of many lists of the best health, medicine and nursing blogs, and Kim has strengthened her spot as a top blogger by creating the inimitable and widely recognized Change of Shift, a blog carnival devoted---but not limited---to all things nursing. 

This is simply a moment to reflect on the gifts that Kim has given to the world with her passion for writing, blogging, Health 2.0 and nursing, and I thank her from the bottom of my heart for all she has done to advance our collective cause. 

Happy Birthday, Kim and Emergiblog---and many more! 

Sunday, July 26, 2009

Saturday Night Insomnia

On this Saturday night/Sunday morning, insomnia pays a visit to my room. Is it the chocolate I ate at the movie? Is it the enormous amount of change and uncertainty in my life at the moment? Is it the insomnia of depression and anxiety? Or is it simply the gnawing knowledge that change is afoot, my mind awash with needless ruminations on the future? 

On these sleepless evenings, I toss and turn, I read, I pick up the laptop, and I eventually collapse in a heap or am lulled to sleep by soothing music or a guided meditation. Lately, I've taken to a form of prayer, reconnecting with the devotional self, a part of me that has lay dormant for far too long. My prayers are like requests for help, requests that I be saved from the runaway train of my mind

Outside, it's a humid and quiet New England summertime night. Nearby, frogs doze in their frog beds, beavers snore in their lodges, and bats circle in the dark air, feasting on mosquitoes. 
The other night, I heard coyotes in the distance, and it made me long for life on the road where we will hear many more wild sounds in the deep, dark night. 

For now, I am comforted by a lamp, the glow of the computer, the sounds in the still night air, and the beating of my own heart. 

Saturday, July 18, 2009

Health Insurance Blues

Most of the readers of Digital Doorway know by now that my wife Mary and I are preparing to leave our static home in New England for an itinerant life on the road. That said, leaving our home necessitates quitting our jobs, and when that paycheck stops rolling in, something else will also end----our health insurance. 

Now, my European friends simply cannot comprehend this, but millions of Americans remain in jobs that they hate for one reason and one reason only---their health insurance. And many Americans who share our dream of self-employment and entrepreneurship also allow their dreams and aspirations to be thwarted by that very same health insurance bogeyman. 

What is it about America that those who wish to do something different must suffer for their choices? Why are there millions of uninsured children who go without primary care because their parents cannot pay for their care? Why do tens of millions of adult Americans with chronic illnesses languish without health care and health insurance? 

My wife and I want to manifest a life of creative self-employment and entrepreneurship, a vibrant engine of economic growth upon which American society was actually built. So, why are we forced to pay extortionate amounts of money so that we can have the simplest, most basic form of catastrophic health insurance? In this country built upon the entrepreneurial genius of those willing to take a risk, why are the risk-takers economically penalized? 

I ponder these questions as we look towards the end of my job, the cessation of our health insurance, and the uncertain road ahead. If we were European, this conversation would never have to occur. In fact, it would be seem ludicrous. 

Will this country ever change? 

Thursday, July 16, 2009

NurseKeith on Twitter

I am honored to have been named among "the 200+ most worthwhile health and medical accounts to follow on Twitter" by the website MedicalFuture. I am in very illustrious company and I am humbled to be included in such a listing. Please check out the list!

Monday, July 13, 2009

The Mind as a Train

I've been under a considerable amount of stress lately. My wife and I are quitting our jobs, selling our home of 11 years, leaving our hometown of 17 years, and starting a new life. Plus I have chronic pain and several other troublesome health problems. In the presence of these concurrent and challenging life factors, I am striving to maintain my emotional equanimity, mental stability, and a healthy lifestyle.

Watching how my mind works and the suffering that I experience when my mind gets the best of me, I can see that my mind is often like a runaway train. There are apparently no brakes, the passengers are screaming bloody murder, and the only refreshments available in the cafe car are drugs, alcohol, cigarettes, junk food, slothfulness, and a host of other unhealthy habits to which we humans so frequently succumb when under duress.

As this train hurtles down the track, I try to disengage and hop off at one of the platforms that whiz by at lightning speed, but it's difficult to get up the courage to simply be calm in the eye of the storm and trust that I'll land on my feet if I jump. And when I do indeed manage to simply stand on the platform and watch the train racing past, my hand will often get caught on one of the train's many handles, and I'll suddenly find myself being dragged alongside the speeding train, once again falling victim to the mind's subtle tricks, even though the only thing I need to do is let go.

Apparently helpless and at the mercy of the chugging engines of ego, depression and anxiety, I am frequently dragged alongside my churning mind, and my body is whipped against telephone polls, street lamps and signs along the way. As I struggle to gain my footing against this consistent onslaught of worry and anxiety, my shoes are torn off, and my bloodied feet drag along the ground as the train continues on its inexorable path.
These images may be graphic, but I feel that it's important to identify the feeling that one experiences when the mind's runaway train controls the trajectory of one's life. It seems that the train can happily speed along it's one-way track of worry and rumination perfectly well with or without my participation, so why not choose to simply sit in the grandstand, drink a cup of tea, and watch the action from that calm vantage point?
I admit it. I daily fall victim to my mind's attempts to keep me worrying, to keep the fretting fresh and new, to continue to enslave me to its wiles. But now, 45 years into the game, I'm beginning to catch on, and I'm seeing the ways in which I make myself miserable. I am determined to continue to learn how to get off at the station, rest my weary self, and be a witness to my mind. The lessons learned from that watchfulness and awareness---often called mindfulness---are ones that I will be sure to share here with you, Dear Reader. If you have a story, tactic or anecdote to share about mindfulness and self-care, please leave a comment, and I will be sure to respond.

Call for Submissions: End of Life Stories

Creative Nonfiction is seeking new essays that explore death, dying, and end of life care, for a collection to be published by Southern Methodist University Press. We’re looking for stories that transcend the “I” and find universal meaning in personal experiences. We hope to include stories representing a wide variety of perspectives—from physicians, nurses, hospice workers, social workers, counselors, clergy, funeral directors, family members, and others. We want narratives that capture, illustrate and/or explain the best way to approach the end of life, as well as stories that highlight current features, flaws, and advances in the healthcare system and their impact on professionals, patients, and families.

Essays must be vivid and dramatic; they should combine a strong and compelling narrative with a significant element of research or information. We’re looking for well-written prose, rich with detail and a distinctive voice.

Creative Nonfiction editors will award one $1500 prize for Best Essay, and two $500 prizes for runners-up.

Guidelines: Essays must be: unpublished, 5,000 words or less, postmarked by December 31, 2009, and clearly marked “End of Life” on both the essay and the outside of the envelope. There is a $20 reading fee (or send a reading fee of $25 to include a 4-issue CNF subscription); multiple entries are welcome ($20/essay) as are entries from outside the U.S.(though subscription shipping costs do apply).

Please send manuscript, accompanied by a cover letter with complete contact information, SASE and payment to: Creative Nonfiction, Attn: End of Life Stories, 5501 Walnut Street, Suite 202, Pittsburgh, PA 15232.

Please share this announcement with anyone who might be interested in submitting work. Please email any questions

Friday, July 10, 2009

The Anchor House Ride

From July 12th to July 16th, my wonderful brother and hundreds of other amazing and giving bicyclists will be cycling their way from Oswego, New York to Trenton, New Jersey as participants in the Anchor House Ride for Runaways.

The Anchor House is "a multi-service agency for runaway, homeless, abused, and at-risk youth and their families" that has "committed its efforts to providing comprehensive, life-saving assistance to our most vulnerable population" for the past 30 years.

As a bicycle-pedestrian activist and avid cyclist, my brother, Ken Carlson, has achieved monumental results in his volunteer work on behalf of his Central New Jersey community of West Windsor, and his support of Anchor House is yet another manifestation of his generosity and kindness. Please feel free to donate to the Anchor House Ride for Runaways as Ken's sponsor, or simply leave a supportive comment here to thank him and his compatriots for their selfless work and dedication.

The Fresh Air Fund Half-Marathon

On August 16th, The Fresh Air Fund of New York City is hosting its annual Half-Marathon in order to benefit the excellent programs sponsored by the Fresh Air Fund for New York City children. If you would like to run in the event or sponsor a runner, please click here for more information.

From the Fund's website: "Since 1877, The Fresh Air Fund, a not-for-profit agency, has provided free summer experiences in the country to more than 1.7 million New York City children from disadvantaged communities. Each year, thousands of children visit volunteer host families in 13 states and Canada through the Friendly Town Program or attend one of five Fresh Air Fund camps."

As a native New Yorker, my father benefited from a Fresh Air Fund scholarship in the 1930s and spent a summer in the countryside, working on a farm in New York State, so it seems natural to post about the Fund after receiving an email from their staff.

May every child have the opportunity to experience fresh air, good health, and the benefits of charitable programs dedicated to their well-being!

Thursday, July 09, 2009

Change of Shift Begins Year Four of Publication!

Change of Shift, nursing blog carnival extraordinaire, is celebrating it's third birthday and the beginning of it's fourth year of publication. I am honored that Bob the Nurse is once again featured in this week's edition, and perhaps Bob will receive more invitations to travel the country from this continued exposure. 

Speaking of Bob, please stop by his blog and check out his latest adventures in Hawaii. He leaves for Arkansas soon, so new travels and destinations await, and he will no doubt pop up on Change of Shift regularly!

Thursday, July 02, 2009

On Vacation

Dear Readers and Friends,

Digital Doorway will be on a brief hiatus until the end of the Fourth of July weekend. Mary and I are on a brief vacation in celebration of our 20th wedding anniversary. Please stay tuned, and visit again next week!

Happy Summer!


Wednesday, July 01, 2009

Exclusive Early Peek at Wikio Health Blog Rankings!

I am honored to have been given a sneak peek at the latest rankings for health-related blogs on Wikio. Digital Doorway is lucky enough to consistently be in the top 50 health blogs on Wikio, and I am happy to share this preview of the newest rankings with my readers. Enjoy! 

1Highlight HEALTH
2Kevin, M.D. - Medical Weblog
3Diabetes Mine
4In the Pipeline
5DB's Medical Rants
6The Covert Rationing Blog
7The Carlat Psychiatry Blog
8John Goodman's Health Policy Blog
9Junkfood Science
10Her Bad Mother
12The Doctor Is In
13Healthcare Economist
14Schwitzer health news blog
15Health Care Renewal
16Six Until Me.
17Disease Management Care Blog
19Musings of a Dinosaur
20Fight Aging!
21The Rotund
24The Last Psychiatrist
25MSSPNexus Blog
27retired doc's thoughts blog
29Cranky Fitness
30hospital impact
31Beyond Meds
32Brain Blogger
33Doctor Anonymous
34Dr. Deb
35Digital Doorway
36The Trouble With Spikol
37Postpartum Progress
38Weighty Matters
39Caustic Musings
42fat fu
43Autism Vox
44Medicine for the Outdoors
45Genetics and Health
46Brass and Ivory
47Eye on DNA
48soulful sepulcher
49Adventures in Autism
50Inside Surgery
51Autism Street
52Natural Variation - Autism Blog
53Autism News Beat
54Capital Health WW-MD's Notes
55A Nurse Practitioner's View
57The Voyage
58The Urban Monk
59Mauzy's Musings
61Hard Won Wisdom
62Jung At Heart

Ranking by Wikio.

Friday, June 26, 2009

The Nurse as Coach

Life coaching has become big business, and now health and wellness coaching is hot on its heels as the next big wave of wellness for the masses. So, why would a nurse make a good coach? What would give a nurse an edge when it comes to coaching willing clients through the process of getting well, maintaining wellness, or increasing one's aptitude for health, wellness and well-being?

Nurses are trained to examine patients/clients in a holistic manner, taking into consideration myriad aspects of an individual's "biopsychosocial" self. From the beginning, nurses are trained to look for areas of both strength and weakness, and nurses are then taught to assist patients in learning new skills which will allow them the maximum amount of independence and quality of life possible.

Coaching and nursing seem to be a match made in Heaven. Coaching is all about helping people to maximize their health and well-being, create a wellness plan, be held accountable for their actions, and produce concrete results in their lives.

As a case manager and a visiting nurse, I have worked with the sickest of the sick, those with multiple life-altering illnesses, and underserved inner-city populations struggling with cycles of poverty, poor health, chronic illness, substance abuse, and institutionalized racism. On a personal level, having removed myself from that front-line world for more than year, I am now ready to work with the well, with those who are motivated and anxious to improve their health, those strongly desiring to take their level of wellness and personal well-being to the next level. Coaching seems to be one of the ways to do such work, and it feels like the right fit at the right time.

Nurses are coaches, for all intents and purposes, and grafting professional coach training onto a nurse's education seems to be a fail-proof avenue to create a new way to make a meaningful living in the world while serving others. If there are any readers out there who have had a positive (or negative) experience with a health and wellness coach, I would love to hear about it. And if there is anyone who would like to experience coaching with me for a very low introductory rate, I am very willing to work with any person committed to their health and open to engaging my services as I power up a new and exciting vocation.

Tuesday, June 23, 2009

"Natural" Beauty

Looking at different natural health and yoga magazines, I am sometimes shocked (perhaps unnecessarily) at how the publishers of such magazines follow the lead of mainstream fashion magazines, ubiquitously populating the pages of their publications with beautiful, flawless young women with clear skin, taut muscles, ample cleavage, exposed bellies and long, tan legs. 

One would think that so-called "natural" magazines would be more apt to use "real" people for their ads and articles, but in this culture dominated by a fascination with youth and beauty, I shouldn't be surprised. 

Perusing the pages of one such magazine, my wife and I were both independently struck with the fact that the pages of this "natural" magazine were filled with nothing but young white women, all of whom were displaying some combination of the attributes described in the first paragraph of this post. 

This type of natural lifestyle is not necessarily just the purview of the young, white and beautiful, yet, if I were an alien and happened to pick up several of these magazines soon after landing, I would be convinced that anyone who did yoga or drank soy milk had the legs of a gazelle and blinding pearly white teeth. If the same alien went to a yoga class, he or she might be disappointed that many of the yogis and yoginis did indeed sport some modicum of body fat and hints of cellulite. 

Alien visitations aside, I am simply appalled that yoga and natural health magazines all need to jump on the homogeneity bandwagon, delivering a bland and culturally narrow image to the soy milk-drinking masses, subtly convincing their readers that the products sold amidst their pages will deliver beauty, smooth skin and glowing health to anyone who happens to be young, white and female. 

Saturday, June 20, 2009

Coaching Myself

I am moving closer to making a decision about becoming a Certified Health and Wellness Coach. This training would help me to synthesize my training as a nurse, massage therapist, yoga instructor and Laughter Yoga Leader into a vocation that can assist others in achieving optimal wellness and self actualization. 

Nurses are natural coaches in that our training revolves around creating care plans that target aspects of health and wellness in need of strengthening, support and change. At its core, nursing is about health promotion, and the heart of health and wellness coaching is the promotion of optimal health and wellness. Taking that alignment into consideration, becoming a coach seems to be a very intelligent career move for any nurse intent on hanging a virtual shingle, so speak. 

As I explore the world of coaching, I can see that there is a vast amount of room in this burgeoning field for innovation, entrepreneurial development, and personal fulfillment. Even more, coaching is work that is 100% portable since most coaches provide their services by phone, email and web-based applications. 

If I move forward with the training over the summer, I may be searching for subjects willing to receive free coaching sessions during my 13-week course, so stay tuned for the day when I send out the call. 

Friday, June 19, 2009

Swine Flu Fears

Over the last few weeks, I've received a number of calls from tourists planning to come to our region for vacation but fearful of contracting the H1N1 virus, previously known as Swine Flu.

Although the outbreak has now been classified as a global pandemic by the World Health Organization due to the number of countries involved as well as other epidemiological factors, the virus is still no more virulent than seasonal influenza. This may change, of course, as the virus mutates and develops in the months prior to flu season, but for now there are no travel restrictions or advisories for any region of the United States.

Still, the calls keep coming, and the nervous visitors fret that they may wind up acutely ill and hospitalized when visiting our sleepy college town.

When these calls come in, my consistent response has been the same: H1N1 is relatively mild at this time, cases are coming to light slowly and steadily, and the number of severely ill patients is small. While there have been several deaths, we must bear in mind that seasonal influenza kills approximately 36,000 American per year, something that can help us all keep the current outbreak in perspective. I also remind the erstwhile travelers that flying on a commercial airplane---with its recycled air and passengers coughing and sneezing---is probably much more risky than a visit to our town could ever be.

Now, my tune may change if H1N1 evolves, mutates and becomes more virulent in the autumn, a potential outcome that may indeed come to pass. Realistically, there are germs and bacteria and viruses everywhere, and I see no reason to live in fear. But for those for whom fear is the paramount factor in the equation, perhaps they should just stay home.

Tuesday, June 16, 2009

Bat in a Basket

So, there I was this afternoon, innocently playing the part of Public Health Nurse Extraordinaire, when I decided to reach for my laptop and sync it with the town network. But, lo and behold, a furry little bat had decided to make its home on my laptop bag, and as I stood, aghast and dumbstruck, it began to crawl and creep in its inimitably bat-like way around the top of my file cabinet.

Closing the door behind me, I calmly made my way to a colleague's office. He's a health inspector and sanitarian, level-headed and pragmatic, and I recruited him in my bat-catching endeavor.

Meanwhile, while said colleague ran in search of heavy-duty gloves, my boss and our administrative assistant insisted on seeing the bat, peeking in behind me as I reopened my office door.

"Don't touch it, Keith. You can't. Please don't," said my boss.

By now, the bat had descended to the table next to the file cabinet and I feared I might lose him. I dashed to the kitchen, found a small wicker basket (the size that might, for reason of illustration only, hold two medium-sized lemons) and rushed back to my office to see the creature still lurking (in quintessential bat fashion, I may add) on the aforementioned table.

At the very moment my favorite health inspector/sanitarian arrived with heavy duty gloves donned, I raised my basket into the air, took three steps---not two, but three---and trapped the bat with a rapid descending basket-like arc.

The bat immediately began to squeal like an otherworldly creature from the Lord of the Rings, and my sanitarian colleague slid a piece of cardboard beneath the now quivering basket. Holding our prey tightly between the cardboard and wicker with our four hands, we traipsed through the Health Department to a blessedly large window intelligently opened by our boss, and the bat in question was released into the cool June New England air, landing with a confused yet simultaneously gentle thud on the roof below. Moments later, he (or she) lifted into the air and vanished into the trees.

Resting on our bat-catching laurels, we returned to our individuals duties, each to his or her own desk once again, and the bat summarily forgot all about us and its adventure inside a local municipal health department.

They don't teach you this stuff in nursing school.

Monday, June 15, 2009

Grand Rounds at ACP Internist

The newest edition of Grand Rounds, the venerable blog carnival of all things medicine, nursing and health care, is up at ACP Internist. Both Digital Doorway and The Adventures of Bob the Nurse are included. Cruise on over if you have a moment to spare.

Sunday, June 14, 2009

Surviving Stress

These days, it seems that stress is the #1 factor impacting my health and the health of many others that I know. From financial worries to chronic health conditions to the multifaceted and fast-paced aspects of modern life, many of us are suffering from stress on some level or another, and I submit that stress universally impacts the health of millions, both as a cause of disease, as a symptom, and as a 21st century illness or syndrome in and of itself.

Many subsume their stress with alcohol, sugar, caffeine, unnecessary spending, and various forms of addiction and emotional sublimation. We all feel the effects, and we all react in our idiosyncratic way to the vicissitudes of life.

On a personal level, I have lately turned to acupuncture, herbs, supplements, meditation, exercise, and dietary and nutritional changes to assuage the effects of stress. Further challenging myself to pursue optimal health and wellness, I have engaged the counsel of a wellness coach who helps to keep me on track as I navigate some challenging personal times.

All of these changes and approaches have indeed decreased the severity of my Multiple Chemical Sensitivity, improved several aspects of my health, and pointed me further down the road towards optimal wellness. Still, certain chronic conditions continue to rear their heads, and I struggle to make more headway in those areas.

The pace of life frequently seems largely untenable, and we manage our lives as best we can amidst the tumult. We eat well, keep hydrated, exercise, seek leisure and fun, connect with family and friends, pursue creative projects and spiritual renewal---all in the name of balance and wellness.

It's a bumpy road, and all too often we lose sight of our own self care as we focus like a laser beam on our latest to-do list and the unending tasks before us.

Personally, I need to take an enormous breath, sit back, and reassess what's really most important in my life. Failing to do so would simply be an invitation for the stress monster to sink it's teeth deeper. In my commitment to wellness and optimal health, it's ultimately a commitment to creating the healthiest, most satisfying and productive life possible.

Friday, June 12, 2009

Of Tetanus and Fishing Line

"I heard you have free shots here, and I think I need a Tetanus shot." He is a friendly middle-aged man with a thick accent.

"Well yes, I usually do, but I don't have any Tetanus today. I'm sorry. But call me in two weeks and I'll have some for sure. Is it urgent?" I ask.

"Not really," he says. Pulling up his sleeve, he reveals a fairly large slice on his bicep, sewn together with blue fishing line.

"I work as a carpenter, and I often cut myself," he explains. "Whenever I do, I get out my needle and fishing line and stitch it up myself." He is obviously proud but simultaneously nonchalant.

"Wow. That's impressive," I reply, examining his needlework and the reddened area around the wound. "Do you know when your last Tetanus was?"

"Not really," he replies, "but I'm sure I'll be OK."

"You can go to several places that offer free care. They may have Tetanus in stock."

"No thanks. I'll call you in a few weeks and get it then. No problem."

I give him my card and tell him to call me in a week or so. My vaccine order is late this month and I feel badly that I wasn't able to make the order in time for this month's clinic. His DIY stitching was indeed impressive, but it drives home the point that there are millions of Americans just like him who have no health insurance and no way to receive even the most basic medical care without a great deal of effort and expense.

So, this man carries fishing line and a (sterile?) needle in his toolbox when he's on the job. How many people walk around with poorly healed wounds, unnecessary infections and God knows what else while corporate executives make off with billion-dollar severance packages?

It's enough to make me want to go fishing and leave it all behind.

Thursday, June 11, 2009

Thursday, June 04, 2009

A Health Coach?

As I contemplate ways to make money and do good in the world without reporting to an office every day, I've been scanning my list of skills and credentials and coming up with some ideas.

Reviewing my vocational history, I am a Bachelor's educated Registered Nurse with 14 years of experience of case management, hospice, ambulatory nursing, home care, community health, and public health. I have skills as a writer, blogger and editor, and have been published in several books.

Beyond nursing, I am a Certified Kripalu Yoga Instructor, a Certified Practitioner of Swedish Massage, a Level I Reiki Practitioner, and a Certified Laughter Yoga Leader.

With some expertise in the areas of Multiple Chemical Sensitivity, case management, and chronic illness management, I find that people often ask me for advice, be it medical, nursing, or simply about life in general.

So, I frequently wonder about the possibility of "hanging a shingle" as a coach, perhaps as a professional health and wellness coach. While the idea is still germinating, I'm working with a health coach myself, experiencing the benefits of such a relationship, and realizing that I have the skills to do it.

Interestingly, a friend called tonight and asked me for urgent medical advice. While I don't picture myself soliciting business for a personal "ask-a-nurse" hotline, I can see that my nursing can indeed be parlayed into a relationship wherein an individual in need of guidance and advice might benefit from the holistic intervention of a coach with a nurse's education.

Speaking of nurses, I have also considered running workshops for nurses on burnout prevention, and perhaps there's a new niche market in being a health coach specifically for nurses and health care providers. After all, we caregivers can be horrendous at taking care of ourselves, so there may indeed be very specific ways that someone like me can help nurses and others figure out how to make the most of their lives, care for themselves well, and optimize their health and wellness.

The wheels are turning, and we shall see how they continue to turn.

Monday, June 01, 2009

Surviving Nursing School

Today I met with a new friend who just finished his first year of nursing school. Listening to his (almost universal) story of the travails of nursing education, my mind wanders back to just how difficult it all was, even as the rose-colored glasses of time filter out the suffering that such an experience entailed.

It's funny how one cannot altogether remember pain. Even women who have been through childbirth often say that they know it was the most painful experience of their lives, but they simply can't conjure up the intensity of the moment. The human brain and body are so self-protective. We easily allow the vicissitudes of life to be covered over with the mental cobwebs of forgetfulness, and I guess that's a good thing.

So, back to nursing school. Why do nursing professors so often make it a living hell? Why does it have to feel like boot camp? If nurses still eat their young, is it assumed that it's best to prepare nursing students for their eventual consumption by roasting them alive as they're educated?

Even though I can't remember my specific complaints about nursing school (and there were two different schools through which I ushered myself), it was indeed a painstaking experience peppered with struggle and angst (especially as an Associate Degree candidate).

All nursing students have my sympathy as they ride the waves of nursing education, often faced with jaded professors and clinical preceptors. Still, there are always gems amidst the stress and heartache, and there were several educators for whom I had the highest esteem and regard.

Yes, we are the most trusted and respected professionals in America, but the process of becoming a nurse can often be rather difficult and distasteful. As Brad Roberts of the Crash Test Dummies once sang: "It's not as bad as eating one's own liver, but I'd like to think that there are better methods."

Friday, May 29, 2009

"Nurse Jackie" Disappoints and Demeans

So, I just finished watching the first episode of "Nurse Jackie", the new Showtime television show about a nurse on the front lines.

What is so disappointing about "Nurse Jackie" is that, in the first five minutes of the premier, this insipid "dramedy" depicts the lead character snorting narcotics while on the clock, forging a dead patient's signature on an organ donor card, lying to said patient's family about the organ donor status of their loved one, and engaging in illicit sex with a coworker while her husband's at home caring for her two young children. Meanwhile, a 1st year nursing student pegs our heroine (or anti-heroine, if you will) as a saint, a designation that Jackie appears to aspire to, "but just not yet".

Now, I'm not so naive as to think that there aren't nurses out there who divert medications, have affairs with coworkers, and engage in all manner of improper behavior. But I take issue with the fact that even though nurses are the most trusted professionals in the United States on survey after survey, the media continues to portray nurses in derogatory ways that undermine our credibility and image in the eyes of the public.

While Florence Nightingale may indeed be the most famous nurse in history, Nurse Ratched of "One Flew Over the Cuckoo's Nest" is probably a close second. Sadly, the premier of "Nurse Jackie" does nothing to advance the cause of nursing in the eyes of the television audience, relying instead on gallows humor, sexual intrigue and drug diversion to add spice to a lackluster premier that demeans nurses and diverts the public's attention from the real story of nursing that is ultimately more compelling than any faux "dramedy" could ever be.

Wednesday, May 27, 2009

H1N1 Creeps Along

The H1N1 virus, otherwise known as Swine Flu, is creeping along at a slow but steady pace, and my work as a public health nurse amidst the outbreak of a novel influenza virus has certainly ebbed----for now.

As predicted by many, the virus is currently no more virulent than your average seasonal influenza, and while more cases and deaths are indeed expected, the rate of the spread of H1N1 is slow and steady rather than rapid and diffuse.

Still, there is a great deal of uncertainty as to what will happen when H1N1 goes somewhat underground over the summer, only to resurface in the Autumn, mutated and ready for the seasonal flu season. Epidemiologists are concerned due to the fact that the 1918 influenza pandemic began with a novel virus emerging in the Spring, spreading slowly but steadily, diminishing in the summer and reemerging in the Autumn, hundreds of times more virulent. Only time will tell.

Another novel aspect of this virus is that, unlike seasonal influenza---which predominately impacts older adults and those with chronic illnesses---the majority of H1N1 cases are those between the ages of 5 and 20, with the vast preponderance being between the ages of 11 and 15. The assumption is that those generations of children have never been exposed to this virus before, whereas the rest of us were alive in the 1970s during the last H1N1 outbreak. And whereas most children and young adults are healthy enough to fight off the infection, there are concerns about children with weakened immune systems and chronic illnesses. When children die from otherwise benign infections, people take notice, and this is an eventuality we all want to avoid.

Be that as it may, the H1N1 scenario is relatively calm for now, and those of us working in public health and other sectors of the health care industry watch, wait, listen, and hope that nothing more comes of this outbreak of a novel virus making its inexorable way around the world.