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

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!

A Hallowe'en Change of Shift

A thrilling edition of Change of Shift is up at Reality Rounds.....Enter if you dare.....

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.

Change of Shift, Direct From BlogWorld Expo!

Here is a link to the latest edition of Change of Shift, sent from the BlogWorld/NewMedia Expo in Las Vegas by none other than Change of Shift founder, Kim of Emergiblog.

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.

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!

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.

Change of Shift Emerges on Emergiblog

Change of Shift, the blog carnival where nursing meets the web, has emerged once again on Emergiblog. Stop on over!

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?"

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........

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!

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.

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!

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.

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.

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.

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.

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".

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.

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.

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!

 

Blessings!

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. 

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!

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!