Human Problem-Solving Experts

Natalie-15

We’re all familiar with the insane nursing shift, the one that brought a TV shows worth of drama and unexpected catastrophe all before you ate lunch that day, the one you won’t soon forget. While many patients and situations follow conventional patterns, humans, the business of healthcare, are inherently unpredictable and often choose to exercise that distinctive quality at the seemingly most inconvenient moment. The range of disturbances can vary from a minor disruption like a patient vomiting in the middle of shift report to a random line of V-Fib resulting in a messy code and a tragic death. We can’t control our patients or foresee the various ways they surprise us on a daily basis and so we learn to evolve in our profession in order to maintain our sanity. As nurses, we become intimately accustomed to the frantic and indeterminable pace of life in our unit and come to expect the unexpected. It’s always better to be prepared for the worst.

Humans aren’t programmable like a computer or machine. They don’t fit a mold and for the most part, can only be generalized in the broadest fashion. Each one is unique from the start and only develop more idiosyncracies along the way including mental problems, chronic conditions, and self-care deficits. People are literally constantly moving and changing as cells duplicate and die, babies are formed and grow, and cellular mutations arise. With so many actions and reactions occurring in people’s bodies every second, it’s not surprising that we often hear unexpected news or detect a suddenly abnormal lab value. It’s actually amazing that so many aspects of our nature go according to plan.

We are all too familiar with our own changes as we have a growth spurt or detect a new wrinkle or realize we can’t run as quickly as we used to as a teenager. Because we understand the human condition personally and because we’ve been wired to respond to challenges with solutions, we can define ourselves as nurses as human problem-solving experts. Sometimes I think nearly everything I do in a twelve-hour shift is responding to one problem after another.

As nurses, we learn to input new information, form a plan of action, and adapt to the changes. A nurse with honed critical thinking skills, the seasoned ability to process information quickly and respond correctly, is worth his or her weight in gold. Many brand-new physicians owe their success (and prevention of killing someone) in their first years of practice to such aptly observant and smart nurses.

As a novice nurse right out of school, you probably don’t already possess those critical thinking skills. Those specific talents can be taught to some degree but are mostly developed and refined through experience. After working for five years on your unit, you now know how to easily handle a situation that would’ve sent you into a panic attack your first several months. Compared to your innocent days, you now know how to talk to difficult patients and get them to comply with a suppository. You’ve inherently absorbed the ability to manage predicaments that would’ve sent you to the bathroom crying previously. Like any profession, nursing hopefully follows an upward curve, with more experience leading to more knowledge and better patient care.

When I first started in the ICU, I was terrified of starting an IV line, mostly because I hadn’t gotten much experience in nursing school. After a few epic failures at the cost of my patients, a kind coworker pulled me aside and showed me where I was operating in error and how to insert the catheter effectively. Thankful for his instruction, I gained a skill that had otherwise been obtuse to me. Months later, I was struggling to keep my patient’s IV line patent as he kept bending his arms and thrashing about in the bed. Rather than trying to insert another line somewhere besides the crook of his arm or use a more effective restraint, I sat at the bedside encouraging him to remain still and restarting the pump every few minutes like a well-qualified babysitter. Even later in my career, I received a patient with absolutely horrible veins, attempted several sticks, then stopped completely, paging the doctor to inform him that I needed more advanced access.

Can you see the progression? As with any job where you start from the bottom, you learn basic skills then develop more eloquent ways of using them to solve your problems. In the beginning, I wouldn’t have recognized that my patient with horrendous veins needed a central line rather than sticking him ten or twelve times. I didn’t have the mental and physical resources to come up with an alternative solution that would’ve proven more beneficial for both my patient and me. I was green and nervous and now I would like to say I’m much more confident, although you’ll never know all the answers. There’s always room to learn.

One particular day will stand in infamy in my mind. I was new, inexperienced and submerged deep in a host of problems much too complex for me at the time.

I received an admission from the ED, a teenager who had swallowed a bottle of pills in a desperate but ineffective attempt at attention. While they had intubated him downstairs and pumped his stomach full of thick, black charcoal to absorb the overload of medications, the tubes and lines only agitated him more. He came up thrashing about, yanking at the restraints with all his available strength and looking at me with manic eyes. With the help of my coworkers, we managed to stifle him with more IV medications and he drifted off into a sedated sleep. Not quite trusting him, I frantically charted an assessment, keeping one eye on his four soft restraints.

Then I turned to my patient in the opposite room.

In the midst of the drama with the teenager I had almost forgotten the depth and magnitude of pain throbbing at the next bedside. A man had suffered a stroke, one that the doctors deemed “incompatible with life.” They offered no surgical option and no medication could be tried. As the pressures built up in his brain, the life was literally being squeezed out of him. And we were all helpless to do anything about it.

His family wailed at the bedside. They laid hands on him, pleading with God for a miracle, some sign of a chance. They wrestled hope desperately, trying to catch it before it slipped away completely. As I tiptoed around the room, trying to be quiet and respectful, more visitors arrived. Then more, and then more. I believe the entire church had stuffed themselves between the cloth curtains as I stood innocuously outside of the room. I wanted to give them their privacy and give the patient the respect owed to a dying man. So I let them gather and pray and didn’t interrupt.

Meanwhile, my teenager awoke in a fury. Banging his hands and legs against the bed, he raised his head up and I saw the inevitable with awful dread. With a thrust of his stomach, he began spewing black charcoal out of his mouth, out his NG tube and onto the bed like a scene out of a horror film. The black spread everywhere instantly as we rushed towards him, trying to keep him from hurting himself. An IV came out along the way and blood entered into the mix. As my coworkers and I grabbed at any available flying limb, one nurse clamped down on my arm with her bloody glove, gripping it with all her strength.

“Yeah, that’s my arm, not his.”

“Oh sorry! That’s gross.”

I washed my arm as someone gave him more medications.

Directly opposite, my dying patient’s family members grew louder and louder, wailing and screaming and beseeching God. Someone started chanting in another language and my coworkers stared at me. I was afraid someone was going to produce a snake out of a purse. With one hand still on my teenager, I panicked, unsure of how to proceed. The disruption was growing to a disturbing level and I felt solely responsible.

My teenager vomited black charcoal violently, staining the room with the mess.

The family members yelled and shrieked at an unmanageable volume.

There was too much noise, too much overstimulation!

And I simply stood in the hallway between the two rooms, literally helpless against the situation. I couldn’t help but laugh, as I truly didn’t know how to handle two such dramatic instances at once. How did I get myself here? What did I sign up for in taking this job? And could you ever imagine such a horrible day as this one?

My manager heard the commotion and came out of her office. After glancing between my patients, she immediately called the charge nurse and someone came to relieve me. It was three in the afternoon and I hadn’t eaten lunch or gone to the bathroom since the start of my shift. She jumped into action, knowing intuitively what I didn’t. She had the benefit of experience that was still foreign and vague to me. I had problems that, with my limited knowledge, I couldn’t solve on my own. I needed help and thankfully, found it at the hands of those around me.

We’ve all had those overwhelming days, those stories you will tell at family gatherings for years to come. We’ve gone home and cried, or called in the next day, unable to face it again in the midst of our exhaustion. We’ve thought maybe we were crazy in signing up for this profession. No one said it was going to be easy. No one said it would come naturally. But as the years and months pass, as we grow more proficient at managing the insanity around us, we become better people, better nurses. We learn to solve problems of every shape and size and do it well.

And as a concurrent benefit, you’ll always have a good story to tell, those stories you will never forget.

Product Review: Kombucha!

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After getting tired of routine beverages like water, tea, and sparkling water, I wanted a liquid treat. I wanted something out of the ordinary that would be good for me, unlike sodas and sugary lemonades or teas. I had heard a fair amount about Kombucha from others in the Paleo world but was hesitant to give it a try, mostly because the “floaties” in the bottom of the bottle sent shivers up my spine. But in the spirit of culinary bravery, I decided to overcome my own personal fears and dive right into the world of Kombucha. Hopefully by the end of this post, you’ll understand why it’s good for you, tasty and a great probiotic alternative to commercial drinks. People also claim a whole host of health benefits like improved digestion, increased immunity and even greater energy, although these anecdotal claims have yet to be substantiated by medical research.

Let’s start at the beginning. What actually is Kombucha? It’s a fermented drink composed of tea, sugar, yeast, and bacteria. Some may refer to it as Kombucha mushroom tea because the “mother” SCOBY resembles a mushroom, but it’s not, simply a compilation of bacteria and yeast. The “floaties” you will see at the bottom of the jar are products of the main bacterial culture called a SCOBY, an acronym for symbiotic colony of bacteria and yeast. The Paleo Mom defines Kombucha as, “a sparking, fermented, probiotic-rich beverage,” and advocates for eating or drinking some kind of probiotic food daily (The Paleo Approach, 228).

th-5 A SCOBY. Although it looks gross, keep reading!

When I first started my intestinal investigation soon after my diagnosis, I had a set of blood food allergy tests run. Now, while many scientific experts don’t consider those tests to be very accurate due to the variation of opinions regarding their reliability, I did test for positive reactions to both baker’s and brewer’s yeast and I instantly resonated with those findings. These are the types of yeasts found in bread, beer, wine and much more. At the time, those were the foods that caused me the most discord so I immediately eliminated them and experienced much symptom relief. From that time on, I was very wary of both yeast and sugars, because an unbalanced amount of yeast in your gut feeds off of complex carbohydrates, like sugars. Anytime I ate any sugar, wheat, yeast, gluten or complex carb, I felt miserable. After following a strict SCD elimination diet for over a month and adding in probiotic foods like homemade yogurt, I began to see improvements in my gut. While the intricacies of my intestinal healing are lengthy, I believe now I’ve restored myself to a healthy gut balance, which now allows me much more freedom in what I eat and drink.

Needless to say when I thought about trying Kombucha, I was wary because of both the sugar and yeast. I don’t tolerate table sugar well at all and try to avoid it at all costs, both for the general health benefits and for my sensitive gut. And I haven’t eaten a bite of anything with yeast in it for years now. However, after doing some research, I learned that the types of yeast commonly used to brew Kombucha are not the same strains that cause intestinal yeast overgrowth. In fact, the Paleo Mom says, “eating foods that contain Saccharomyces boulardii or other beneficial yeast does not increase the likelihood of getting a yeast infection or overgrowth (a common misnomer). In fact, eating beneficial yeast can help treat a yeast infection.” The Paleo Approach, 224. And the fermentation process breaks down much of the sugar, thus limiting it’s effect on your gut.

However, a word of caution. If you are having a plethora of gut problems and suspect bacterial and yeast overgrowth, it is wise to avoid probiotic foods until after a few weeks on an elimination diet and then add them back very slowly, only a teaspoon at a time. If you’ve healed yourself from any leaky gut issues or don’t have any current problems, go ahead with trying some Kombucha!

Another word of caution: the fermentation process does produce a tiny amount of alcohol as a byproduct. If you’re pregnant, have an alcohol sensitivity, or have a compromised immune system, it may be best to avoid Kombucha. Most medical personnel don’t recommend any alcohol or unpasteurized bacteria during pregnancy so better safe than sorry. If you want more information, read this post from The Food Renegade regarding pregnancy and Kombucha.

You can make Kombucha at home and can buy kits online. While it’s safe when made correctly, you have to ensure that you follow the directions strictly to prevent any unsafe bacteria that could make you sick. As long as you abide by the instructions, you should do well. For a great tutorial, see this post from the Kitchn.

I tried several different brands and flavors over a period of time, trying to find my personal favorite. Since Kombucha’s popularity has sky-rocketed lately, you can find commercial brews in refrigerated cases at many health food stores. While a bottle isn’t cheap (usually $4-5), I believe the health benefits make up for the cost. If you want it for cheaper, consider making it yourself at home.

All the brands listed below are organic. I did not receive any compensation for writing this post so you know my opinions are true! Here we go:

th Live Soda  Austin, Texas. When I first tried the Pure Doctor flavor, I immediately looked at the bottle, wondering if somehow I had picked up a Dr. Pepper soda instead. Truly, it tastes amazingly similar to the commercial drink and would be a great alternative for someone trying to wean themselves off of sugary sodas. Since I’m not used to so much sweetness anymore, it was too much for me. While all the flavors are delicious, I would pick up the Living Limon flavor instead (It has Stevia so keep reading labels if you don’t do alternative sweeteners).

th-1 Buddah’s Brew Austin, Texas. The Pineapple Super Greens is a completely unique flavor that is both delicious and healthy and instantly captured my attention. They also make rotating seasonal flavors in mason jars, which is pretty cool, you have to admit.

 

 

th-2Holy Kombucha Fort Worth, Texas. You have to try the Blood Orange flavor. Seriously. It’s yummy and fizzy and totally defies any construct of your tastebuds.

 

th-3 Synergy GT’s Kombucha I tried the Lavender flavor because it struck me as unique and different but I didn’t like it as much as I thought I would. On the other hand, I also tried the Strawberry Serenity and I think it was my favorite flavor out of all the Kombucha flavors I tried (I’m a crazy strawberry fan so that’s not surprising!) Syngery makes several different variations of Kombucha, some with a lighter feel, so try them all and pick which type you like best.

 

th-4 Kevita I picked the Hibiscus Berry daily cleanse and savored it for a while. Since Kevita has a ton of different types of drinks, including organic coconut sparkling water!, I will be buying more of these!

If you’re new to the world of probiotic foods and drinks, I hope this post gives you a better understanding of why you should consider braving a new beverage. If you’re a seasoned Kombucha veteran, leave a comment and tell me which flavor is your favorite!

Sources: The Paleo Mom website and her book The Paleo Approach.

For the Love of the People

Natalie-12

Most people don’t go into the profession of nursing for the fame or fortune. Instead, we do it because of that nagging altruistic feeling that settles in our gut. We do it because we’ve seen suffering or suffered ourselves and seek to enter into the depths of those tragedies and triumphs. We do it for the lost, the broken, the hurting, the lonely and the tormented. We clean up horrors beyond your imagination and deal with angry, yelling family members, simply seeking an outlet for their grief manifested in rage. We get up earlier than most, work longer days than many, and rely on relatively few “thank you’s.” We do it not for ourselves, but for the love of the people.

At my urban hospital, I see the indigent and abandoned, those who are plagued by mental illness, chronic disease, and substance abuse. I deal with people who ignore their physician’s instructions, landing them back in the hospital time after time. I am intimately acquainted with those ignorant of the healthcare system, those who, despite all of our pleading, let their family members live out the rest of their days in a hollow existence, loitering in the void between life and death with little quality of life. I am forced to ponder obtuse ethical questions, deal with impossible situations, and to be brutally honest, at times linger in resentment and callousness. I am compelled to wrestle with those questions for days afterwards, trying to come up with a better solution for unmanageable issues. Sometimes I leave confused at the disadvantaged, out of pity wondering, “how did you get here?”

I’m not trying to get political here and rant about the problems inherent to our healthcare system. There are many positives and negatives and I will leave that discussion to people far more educated and opinionated than me. The point I’m trying to make, the thesis of this examination, is that lives are valuable. If we didn’t believe that, we wouldn’t work so hard to protect them, heal them, restore them, or guide them gently into death.

An older African-American woman randomly contracted a very rare and very fatal disease, one that was already leading her towards the light. She was no longer conscious, not able to talk or eat on her own, and couldn’t move. She lay in the bed with tubes and machines that would accompany her to her death.

Having seen many such cases in my career, personally I wouldn’t want the remainder of my unconscious existence with a terminal condition to be constituted of lab draws and ventilators and feeding tubes. I would want to go quickly and in peace and I would desire the same for my family members. But people don’t always make the decision you would.

This woman’s family decided to keep her alive in her vegetative state in the vain hope that she might wake up. Despite all our education, consoling, and pleading, they remained unchanged. That woman would live out the rest of her life in an uncomfortable intensive care and the reality of the decision, the heartbreak of it, got under my skin.

As healthcare professionals we can educate and encourage people in what we deem as the right direction, but we can’t force their hand. There are many frustrating moments where we lament the choices made, but it’s not our mother or father or husband. Up to a point, we can’t control people’s final decisions and sometimes that drives me mad. This particular case haunted me as I ruminated over the injustice of such an existence. Not that I’m always right, but from a personal standpoint, it killed me to watch her waste away in the bed, her body literally decomposing before us. I had tried my best and the family decided to follow another path than I would’ve chosen.

On those particularly trying days with particularly sticky situations, you wonder if it’s all worth it, if this job that seems to suck the compassion and strength right out of you, is a calling or a masochistic inkling. Did you trick yourself into believing that you were truly making a difference? Did you fall prey to some propaganda scheme that propped up your hopes of changing the world and the people in it? Those days can make you question whether your sense of kindness has evaporated over the relentless twelve hour shifts and all that remains is a solely a romantic notion to make you feel better.

A young woman in her forties put a gun to her head and pulled the trigger, trying to silence years of Bipolar disorder and alcoholism. She left behind two young children who would never grow up to know their mother. Her father, an older man marked with years of abuse himself, looked up at me tearfully and said, “she was a sweetheart when she wasn’t drinking.” We proceeded to have a mournful but cathartic conversation about her hobbies, her favorite time of year, the people’s lives she had touched in love.

“I’ve been sober for thirty three years now,” he said, wiping away a tear from his face. “I wish she could’ve done the same. Now she’s in the hands of God.” We hugged and both shed a few tears and remained together in silence as the family prepared for her imminent death.

In contrast on those days, as I hold the hand of a mourning father, I remember that the hope that seemed so far buried, does not lie dormant. I recall the reasons why I chose this crazy career in the first place. It wasn’t for my own self-satisfaction necessarily or to go home at night and never have to deal with those frustrating and painful emotions. I knew going into this job that it wouldn’t be the easiest or most convenient career. I do it for the love of the people.

We simply believe lives are valuable, both those of our patients and families and we seek to help them through some of the most difficult moments. Someone holds your hand and thanks you for saving their life. A former patient walks back in the door months later, almost fully recovered from a traumatic brain injury. A parent cries with joy when their child starts to follow commands, and you cry with them. You see firsthand the fruits of your toiled labor, the labor that you never really expected a return on. It’s simply a gracious gift.

Whether you deal with an indigent or wealthy population, the educated or illiterate, the consciencious or the apathetic, the words you speak and the acts of your hands do not go unnoticed. There are still many aspects of healthcare that frustrate me, choices that seem to defy logical sense, and poorly managed decision-making situtations that result in grevious ends. Like any career or profession, it’s not perfect and the cracks with always remain.

But despite the day, frustrating or invigorating, happy or sad, meaningful or banal, people are cared for and lives saved. In the end, both the patient or family and me benefit from our exchange, trading meaning from the situation to make sense of life’s curve balls. And it will always be worth it.

After all, it’s all for the love of the people.

 

Whole 30

th-1With all the media popularity recently, you’ve probably heard of a diet and lifestyle approach coined the Whole 30. Creators Dallas and Melissa Hartwig refer to the plan as a “powerful 30-day nutritional reset,” and it has exploded in popularity as people have seen dramatic results. Many people have found the outlined plan very effective for losing weight, reducing disease and gaining a healthier lifestyle and food perspective. The book It Starts With Food outlines the reasoning behind the 30 day plan, the logistics, meal plans, shopping guides and a whole host of other resources to get you prepared and through the thirty days successfully.

Everyone comes to dietary crossroads for a different reason. Some want to lose weight, some reduce disease, and others to understand their bodies better. The Whole 30 addresses all those needs. By eliminating a whole host of inflammatory foods and those that cause cravings, the Whole 30 plan helps to heal your body from any imbalances as well as banish that after-dinner sweet tooth. Many people realize (or don’t even recognize) that they have an improper and unbalanced relationship with food, meaning you are a slave to your food rather than being in control of your habits. The 30 day “reset” helps you to take charge of your eating routines for the better.

For people who are just beginning to learn about dietary changes, they might find this all a little overwhelming. Eliminating all sugars, grains and dairy for a whole month? No way. Five years ago it would’ve seemed daunting to me and even after we changed our diet for the sake of my health, I threw some pretty spectacular tantrums from time to time so I can relate. You can read my UC story here. For people who are already familiar with Paleo or other similar ways of eating, they don’t have as far to come and may enjoy the additional challenges of the Whole 30. To make getting started really simple, they provide you with easy steps in this post. There are a couple of simple admonitions that the Hartwigs endorse for sticking to the Whole 30 plan:

  • Absolutely no cheating! To use a quote from their book, “Beating cancer is hard. Birthing a baby is hard. Losing a parent is hard. Drinking your coffee black. Is. Not. Hard.” Even a little bite or sip of any of the outlawed foods can send you back into cycles of cravings and destroy all your hard work. Stick with it!
  • Stay off the scale. The Whole 30 doesn’t require you to count calories or input everything you eat into an online calculator. It’s about eating real, healthy food, not focusing on the pounds.
  • It will require some effort. Because most dishes you order at any restaurant are not Whole 30 approved, you will have to eat the majority of your meals at home and learn to cook. Since fresh fruits and vegetables do not magically appear on your doorstep, you will need to plan meals weekly and make shopping lists. Don’t just wander into the grocery store unarmed and uneducated or you will likely fall into some erroneous patterns.
  • The majority of your meals should consist of healthy meats and vegetables with fruits as part of the meal occasionally (not as a snack). Snacks should include protein and fats (not just fruits or veggies). Eat three meals a day and avoid snacking if at all possible. You can find a whole list of other recommendations in the provided Whole 30 resources.

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Pictured above: Coconut curry vegetables

Yes for Whole 30:

  • Meats and seafood (preferably organic, grass-fed or wild-caught)
  • Vegetables
  • Occasional fruit
  • Clarified butter or ghee
  • Healthy fats like olive or coconut oil
  • Coffee (only one or two cups/day with no dairy or added sugar)

No for Whole 30:

  • Sugars-natural or artificial (including white sugar, honey, agave, maple syrup, Splenda, stevia and others.)
  • Alcohol (not even for cooking)
  • Grains (including traditional grains like wheat, oats buckwheat and also quinoa and rice)
  • Legumes (including all kinds of beans, chickpeas, peanuts, soy or tofu)
  • Dairy (including cow goat or sheep products.) Clarified butter IS allowed.
  • Starchy vegetables (including white potatoes and corn)
  • “Paleo treats” including sweet treats made Paleo-friendly like pancakes, waffles, muffins, brownies, ice cream and cakes.
  • Additives, nitrates, unnatural preservatives and other nefarious ingredients. If you don’t recognize the names on the label, you should probably put it back on the shelf.

There are some simple exceptions listed here

While I’ve done a modified version of the autoimmune Whole 30 in the past, I wanted to try a traditional Whole 30 to help control and eliminate my sugar cravings. Lately, I can’t go to bed after dinner without a sweet treat and find myself absently eating Paleo sugary desserts without being able to resist. Since I don’t want to be held hostage by my eating habits, I’m starting on this journey to get another perspective on my relationship with food. While I’ve spent an enormous amount of time researching ways to heal my Ulcerative Colitis, I haven’t done much soul searching on how I deal with food cravings.

We already eat very close to the Whole 30 plan, having modified my nutritional needs over the past two years in hopes of reducing disease. But I believe there’s always more to learn and we should never grown complacent so I’m ready to try another route. Needless to say, I’m excited for the next month and I’m sharing this information with all of you because I truly believe it is a very effective way to become a healthier person! My blogger friend Andrea is a HUGE Whole 30 proponent and you can read more about her Whole 30 experiences on her blog Loubiesandlulu.

This is simply my personal summary of Whole 30 and you can find all the details on the Whole 30 website and in the book It Starts With Food. Especially if all of this seems foreign and you’re new to this way of eating, I would highly suggest getting the book (it’s not only very knowledge-based but also funny and inspiriting. Good luck!

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Watermelon spritzer: frozen watermelon juice, carbonated water and lime juice.

The Cursed Bed

Natalie-9First of all, I want to thank everyone who visited the site and those who commented since my last nursing post, the Double-Edged Sword! It’s so humbling to read comments from nurses from different areas, different parts of the world, and different life stages, and know that I was able to give a voice to a common theme. Honestly, I had no idea that this post would be so popular as I was simply trying to express those nagging feelings in my gut that wrench at me from time to time. It’s cathartic to verbalize those emotions and it seems like it was for everyone else too. It’s a dense topic, arduous to navigate and process through, and we all couldn’t do it without the help of others. Thank you for your support, your dedication to the nursing profession if you fall into that category, and to those non-medical people who provided another viewpoint to the topic of compassion fatigue or emotional guarding. I appreciate every word.

I use the word “cursed” mostly as a nervous joke but the following patient got under my skin, even brought me to sheer panic, and you will soon understand why. For a period of time, one particular bed haunted me with disturbing patients and I vowed that if I was ever admitted for an accident, I would demand any bed but this one. For months, I subconsciously picked assignments on other sides, not wanting to relive some of the grevious experiences I encountered with patients in that bed. Here is one chilling tale…

His eyes seemed to glow nefariously, like a smoldering flame, darting back and forth suspiciously across the room. He refused to speak, only grunt at anyone who came near him. His hands were calloused, spindly ropes of non-compliance, clenched into fists beside him in the bed. Without staring at him for too long for fear of meeting his eyes, I could see scars lined up across his worn face as evidence of dark days. I also noticed the scars on his arms surrounding his veins, confirming his drug habit.

“Sir, can you tell me your name?” I asked hesitantly. He only responded with an aggressive, animalistic sound.

It was the beginning of the nightshift, the winter pitch-black sky peeking out at me from behind the blinds in the room. With only distant beeping noises, the unit was quiet, contrary to the usual raucous nighttime routine inherent to an active intensive care unit. This room, separated only by curtains from the vacant adjoining beds, was situated at the end of the dim hallway and the hazy florescent lights flickered inconsistently as if to confirm my suspicions. Feeling unsettled, I wondered if anyone would be able to hear me scream at the nurses’ station at the other end of the hallway.

I watched him for a moment, noting the labored rise and fall of his chest. The slits for his eyes rested barely closed, as if he was watching me covertly, prepared to react at any sudden movement. He was a rough man, well accustomed to the hardships of life with mental illness and the dangers of living on the streets. With an anonymous address listed for a location under a highway, he was brought in without family or friends. I don’t remember his diagnosis or his chief complaint but I recall feeling sorry for him, wondering what set of circumstances landed him here, alone and broken. But despite my compassion, the lingering sense of uncertainty remained, weighing me down.

Only about a year out of nursing school, I gathered my supplies, stuffing my pockets with alcohol wipes and saline flushes, and threw my stethescope around my neck like a good novice nurse. With my relative lack of experience, I couldn’t see the dangers lurking behind his disconcerting eyes. I wasn’t prepared for what would happen. I entered the room trying to be confident, chalking up my intuitive fear to cowardice.

“Sir, my name is Natalie and I’m going to be your nurse tonight. I just need to do a quick assessment and then I’ll let you get back to sleeping.” He didn’t respond, didn’t move. He sat there motionless, like a cat waiting to pounce on a mouse.

I checked the alarms on the monitor, running through my safety assessment with one eye fixed on him. I fiddled nervously with my hands as I hesitated mentally over whether to touch him or not. I finally decided I needed to harness some bravery and continue with my work. I stepped over to the side of his bed, his eyes still closed and his breathing heavy. I glanced back at the heart monitor as the beats crossed the screen in a slightly irregular rhythm.

“Sir I’m going to check your IV lines now.” My voice shook but then I cleared my throat and tried again, hoping to sound more in control. “It will only take a minute.” I unclamped the tubing, cleaned the port and attached the saline flush. I started to push it in very slowly, expecting some kind of reaction from him. Still, he didn’t move.

Somewhat encouraged by his lack of response, I moved to the other side, doing the same with the IV line in his right arm. I pushed the saline flush faster this time, at the normal rate. I was almost done and he spoke suddenly.

“Don’t touch me.” The tone of his scratchy voice sent my hopes for a decent night to the pit of my stomach. His voice was cold and rough, marred by years of trials I couldn’t imagine. He said it calmly, without emotion, like a very real threat and a shiver passed over my entire body.

No movement, eyes closed, rise and fall of his chest in synchronized motion.

“I’m almost done if you’ll just give me a minute. Let me listen to your heart and lung sounds first.” I yanked my stethescope off my shoulders and quickly placed the earpieces into my ears. I picked up the end of the device and brought it near his chest, trying to get my assessment over as quickly as possible.

“I’m warning you, don’t touch me.” Since I couldn’t clearly hear him, I slipped one of the earpieces out slowly as dread filled my gut. He said it again, slowly, with precision over every word. “I’m warning you, don’t touch me.” My hand shook and I gripped the piece of equipment tighter.

“Ok well let me finish and I won’t bother you again.”

One of the slits of his eyes opened abruptly as he stared straight at me. Creepily, the other one remained shut. Shocked and scared, I took a step back immediately. “Did you not hear me?” he said, getting more irritated. “I said I don’t want to be touched.”

Since my gentle encouragements had yielded little progress, I gave it some force, all the force an innocent twenty two year old girl could manage. “Sir, you are in the hospital for a reason, because you’re not well, and I’m trying to take care of you. I’m just doing my job. Let me listen to your heart.”

The slit closed again. Up and down went his chest. No reaction.

I stood there for a long moment, trying to decide if his silence indicated agreement or dormant rage. Bolstering my bravery yet again, I placed the stethescope on his chest and leaned down towards him. I could smell the dirty stench that coated his skin. I barely let out a breath as my rising fear choked me. I felt like the lamb lying down with the lion.

In a split second, the entire situation changed.

His eyes snapped open, wild and full of wrath. He started to scream, a tortured wail that thrust me away from him. I scrambled backwards as he lifted his leathery arms into the air and pulled out one IV, then the other, splashing blood all over himself and the bed. He let out another scream and clenched his hands into desperate fists as if a lifetime of anger had finally spilled over in this instant. Seeing the sheer insanity in his eyes, I think I’ve hardly ever been that afraid. He barely looked human anymore.

“Help! I need some help down here!” I cried in desperation. My cohorts recognized the panic in my voice and came running to my abandoned end of the hallway. With his chest lifted, he looked like he was about to jump out of the bed, focused on me as his target. I couldn’t move, couldn’t breathe. I was frozen in fear as this crazy man pushed down on the side rails in order to boost himself up. He was about to lunge, aiming for me.

Suddenly, out of nowhere, I saw one of our male nurses throw his body on top of my patient, slamming him back into the bed and away from me. Another grasped the patient’s arms and held them to the bed. Someone else got his feet. Everyone was yelling and throwing equipment at each other as someone else called for the physician. Completely stunned, I couldn’t even react as I watched everyone in rapid motion.

It took six nurses, four of them strong male nurses, to simply keep the patient from catapulting out of the bed. He thrashed and howled, kicking vehemently against them, and they shielded their faces as he started to spit. Two hands rapidly and expertly placed restraints on the patient’s arms and then two more on his legs. Even with the restraints, the patient bucked and whipped his head back and forth, screaming and biting at the air in sheer rage as his spittle flung across the room. Someone got their hands around his neck long enough to put a paper mask over his face to protect the nurses from his bodily fluids.

Then, as if it couldn’t get worse, it did. The patient screamed again, mustering all of his strength, and thrust upward so hard that one of the restraints on his arm broke and his arm went flying into the air. The nurses grabbed the liberated appendage and clamped down on it with white-knuckled hands. They looked at the destroyed restraint and then at each other helplessly. That never happened.

“We need some IM Haldol now!” the doctor said as he ran up breathlessly. His eyes scanned the situation, instantly registering the severity of the circumstances. Without any remaining IV access, we couldn’t give the patient any of the intravenous medications we would normally try first. We would have to inject the medication into his deep tissue to absorb. Hopefully then we would be able to hold him down long enough to get another IV line.

A fellow nurse ran back from the medication station with the drug and threw it to another nurse with a syringe in hand, ready to draw it up. In only a few seconds the male nurse who had first jumped on him inserted the needle into his skin expertly. In his fury, the patient didn’t even register what had occurred. Still holding the patient down firmly, we waited for the medicine to take effect. I watched the male nurses with a new level of gratitude as beads of sweat collected on their foreheads. I thought maybe I wanted to cry.

The male nurses remained over the patient as one of them carefully pulled out a catheter needle and searched for an acceptable vein on his arms. With all of his scars from drug abuse, there wasn’t much to choose from and he searched for several minutes before finding one he could try. With the heightened precision that accompanies a true emergency, he slid the catheter in, the needle out, and hooked up the IV tubing. Per the doctor’s orders we gave another dose of medication into the line. It took several doses before he started to calm.

After a few minutes, the patient’s grunts diminished and his strength surrendered. Little by little, not trusting him in the least, the nurses lessened their grip on him as they placed a second set of restraints on the patient. We wouldn’t go through that again. Few words were spoken as everyone caught their breath, attempting to recover from the rush of adrenaline.

The patient lay there with eyes closed, his breathing starting to calm. I could still see his veins sticking out on his forehead from the exertion. I couldn’t get the image of his crazed face out of my mind, watching helplessly as he was about to pounce on me. With all the excitement, I could hardly process what had happened. Someone put a chair behind me and I sat down. The doctor ran his hands through his hair and exhaled deeply. A wave of relief washed over me. We were all glad that was over.

I related the events of the night to the doctor as he adjusted my orders. “Well he’s going to get what he wanted. Don’t touch him for the rest of the night. I’ll put in the order.”

So I sat at my patient’s bedside for the rest of night, simply scrutinizing the monitor and trying not to disturb him. I tried to imagine what thoughts ran through his brain, what voices were speaking to him, what instincts motivated him to attack us. We would probably never know, and despite his crazed outburst, we were there to help him. We wanted him to be set free from the terrors that haunted him. We tried our best to confine and contain him but there was little we could do to liberate him. With an unexplainable mix of compassion and sheer terror, I ruminated over my patient, keeping a close eye on his every movement.

And with the slits of his creepy eyes almost closed, lying limply in the bed, I knew he was watching me.

The Double-Edged Sword

*Forewarning- this nursing post can get graphic in some places so read at your own risk!

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Sometimes I wonder how to maintain a balance.

Just the other day I watched a man in his early forties, who had come to the hospital after an accident, bleed to death. With his leg wrenched off, a mess of shreds of flesh and coagulated blood, he had reached the end. The doctors took his wife to the bedside and calmly but firmly explained that there was nothing else they could do. The damage was too severe, the injury too great. The dripping blood collected in a pool underneath him like a morbid summary of the sad tale.

I watched for a few seconds like an unattached observer, noticing the inconsolable wife and other family members with a haze of self-protection between us. With only a dormant ting of grief, I watched as the wife laid her body over her husband, begging and pleading into the air for him to live. Her desperate but vain requests fell upon a silent room as she screamed and wept. Her tears wet his face but he didn’t move, already drifting in the middle place between alive and dead. Finally he passed away slowly and quietly and the family was left with some privacy to grieve. After such a commotion, the silence was deafening.

Functioning as the charge nurse that day, I was aware of the situation but because of the hectic pace of the unit at that time, I didn’t have the mental energy or space to soak it in fully. I cognitively understood but I held back my emotions for the sake of the job, for the sake of keeping the unit functioning at the highest level. Patients needed to be admitted from the  ER or OR, nurses required help with bedside procedures, and some of our other patients were declining at a rapid pace, requiring all hands on deck as we hung blood pressure medications and put in chest tubes. If you’ve ever been the charge nurse, you understand the feeling of the weight of the hospital world on your shoulders, the responsibility of life and death weighed around your neck. When you’re the charge for the trauma ICU, with everyone in the hospital calling you to fix a problem or make room for a patient, in many ways those are accurate assumptions.

There’s a fine line between entering into the emotions of the situation and preserving yourself for the sake of the job. A conundrum common to any area within the hospital realm. Nursing can be a diabolical and equivocal profession for this very reason: the maddening crux of self-protection and compassion. It’s a double-edged sword that boasts both danger and power.

On one hand, I consider myself to be an extremely sensitive person who relates to my patients and families on an emotional level. In my job working with families, I sit and listen as they vent about frustrations or griefs. I cry with them as we turn off the machines and let their family member drift into breathless silence. My heart aches inside of me as families have to make impossible decisions about the future of a loved one’s care. Few choices are straightforward and easy, and most require all they have left emotionally, mentally, and physically. Sleep, proper nutrition and self-care become obsolete as families focus whole-heartedly on the task at hand, the healing or demise of their loved one. I’ve gone home and cried helplessly because of a devastating patient situation, the grief and loss too much to bear. Seth has listened as I relate some of the horribly unfair circumstances that are inherent in a broken, fallen world. I function in deep compassion for my patients and families, empathizing with them over their heartbreaking situations.

Regardless of the specific area, nurses are not strangers to the unlucky, unfair circumstances that plague humanity. From oncology to NICU to outpatient clinics, we all encounter the unexpected test result, the unbelievable diagnosis, the unexpected and tragic turn of events. We experience on the ground level variations of pain and loss that many people can’t comprehend. We are exposed to some of the most triumphant and desperate situations, watching people defy the odds or succumb to the inevitable. Nursing is a highly emotional profession with the pendulum swinging between hope and loss, pain and victory, life and death.

On the other hand, I felt completely unattached to the man dying that day, knowing that if I let myself indulge, a deluge of tears would follow. I went to a party after work that night and as my  mother asked me, “how was your day?” I related the incidences in a matter-of-fact tone that seemed to shock her. I realized abruptly that it wasn’t normal for someone to say they watched a patient bleed to death, while sipping iced tea at a wedding shower. In my callousness and self-preservation, I hadn’t even stopped to wonder at my own disillusionment with the situation.

But as nurses, we can’t always allow ourselves full depth of emotion at a certain time. It’s one of the disadvantages and hard boundaries that come with the job. If I imagined Seth lying in the bed as the patient and me, the desperate wife, weeping over him, I surely wouldn’t have been able to continue with the day. I would’ve been overwhelmed with inconsolable grief at simply the thought. I would’ve sat down dejectedly at the bedside and ignored the other duties required of me.

Nurses get very extensive training in assessment skills, safe medications practices, and the scope of our license. But treading the fine line between emotional indulgence and self-protection is something you have to learn on your own, in your own way, so that you can go back to work the next day and be satisfied with your profession. Everyone comes to that place, the place of peace with difficult circumstances, at their own pace and in their own fashion. And it changes as you move through various stages of life. You constantly have to reevaluate yourself, your calling, and your emotional reserve to adapt to the situations before you.

Sometimes I’m amazed at my ability to push my emotions aside and continue in the job of saving lives. Sometimes I’m surprised as I can’t seem to stop ruminating over a seemingly routine but difficult situation. I shock myself with how I react to some predicaments and not others, or the degree to which I react.

It’s an impossible double-edged sword, the blade of self-protection and compassion. It gleams at you, waiting for you as you walk into work everyday. You wield it as best you can, trying to make the wisest choices, but sometimes it cuts you when you least expect it. Then you remember it’s both your weapon and your downfall, and you grow in respect for it.

We pick it up before a shift and lay it down afterwards, but we all know it’s never far from us.

 

Stages of Transformation

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I used to think theories were solely academic, over-analytical and obsolete. I labored over them in my nursing theory undergraduate course years ago, deeming the whole endeavor as functionally irrelevant, until I came across one that dramatically changed the way I viewed the world. Therein lies the point of theories actually: to shape the way you view your circumstances, life events, and the world at large. Theories give us a framework to ingest and organize the overwhelming amount of data we receive on a daily basis. And the one that stuck with me, Kubler-Ross’ stages of grief, has in a very practical sense shaped the way I processed through my disease diagnosis and still mentally manage the idea of a lifelong chronic illness.

Dr. Elizabeth Kubler-Ross developed her model of stages of grief initially based on her work with terminally ill patients but the model can be applied to a vast variety of heartbreak, transition, and trials. The stages include: denial, anger, bargaining, depression and acceptance. Some people work through one at at time, others bounce between stages in no particular order, and others skip stages completely. Mimicking human nature in general, the stages don’t fit every person exactly.

In my case, I walked through these stages very clearly and mostly in order as I tried to digest the idea of having Ulcerative Colitis and the life-long ramifications of such a drastic change. Since I found this theory to be extremely insightful and comforting in dealing with my chronic illness, I thought I would share my experiences as I passed through each of those stages to finally come to a place of peace with my condition. While I’ve journeyed through these stages with my disease specifically, I’ve also walked through them in other lamentable life circumstances like the end of a relationship. My hope in writing this post is that people going through a whole manner of trials including divorce, disease, the death of a loved one, or simply a tough life transition can relate to and derive some encouragement from my words. In a way, this post is an extremely simplified version of the book I’m trying to write, which explains the details of each stage of transition along with excerpts from my journal that accompany each different phase. Some of it is comic, some seemingly pathetic, some heartbreaking, and some triumphant, but it all works together to tell a story of victory in the midst of trial.

DENIAL

When I look back upon the circumstances surrounding my diagnosis now, I’m not in the least surprised that this was my breaking point. At the time, I was dealing with a whole host of overly stressful circumstances including a particularly difficult breakup, finishing my last semester of nursing school and college, and trying to find my first career position as a nurse. I was overwhelmed, overworked, and prone to overreacting. The combination of life circumstances, long-standing GI issues, and my own innate controlling personality sent me over the edge.

Through the haze of extreme fatigue and the anxiety of starting my position as a registered nurse in the trauma/surgery intensive care unit, I remember those defining moments vaguely, as if I watched someone else float through it, not me. The words “Ulcerative Colitis” from the physician, the onslaught of medications, and the shock of such a dramatic life change left me confused and overwhelmed to the point that I couldn’t comprehend it all. I swallowed my pills, hardly slept from getting up to the bathroom so many times, and soldiered on. In the midst of switching from day to night shifts, I didn’t have the time or mental energy to deal with my new diagnosis. So while I understood my circumstances, I chose not to ponder them in-depth or make any life changes. I relied on steroids for my strength and tried to make it through my nurse training, proving that a new diagnosis wouldn’t prevent me from obtaining my dream job. This worked for a while in self-preservation until I could no longer ignore the nag of reality.

ANGER

Not surprisingly, I journeyed through the anger stage several times, reverting back to it as my default coping mechanism. Like any normal person, I balked at the atrocity that something so horrible would happen to me. Shouldn’t older people get chronic illnesses or people who don’t take care of themselves? Why, after eating healthy my whole life and exercising, always adhering to the rules, should I be the one to get debilitatingly and desperately sick? Why me? Why, in the prime of my life, should I spend my early twenties constantly looking for a bathroom and being insecure about my steroid moon-face? I realize it sounds extremely self-involved with the undeniable undertone of entitlement but there’s nothing like a chronic disease to get inside your head.

Since I’m a Christian, I viewed my circumstances through the lens of my religion. I was angry at God for allowing this to happen. I couldn’t understand his purpose in it and couldn’t see past any of the sadness to the hope of better days. Childishly, I felt like I had followed the rules and didn’t deserve this kind of treatment. Despite what I knew cognitively from the Bible of others who had journeyed through trials, of the long-standing hope of God’s redemption, and the love of God for his children, I couldn’t get past my immediate concerns and selfishly I took out my rage on God.

I also discovered I was angry at myself, for being myself. In some twisted way, I shouldered the culpability for my disease, as if my anxiety and need for control had hurried the advent of this condition. It took many long conversations with good friends for me to see that I didn’t cause this to happen and I couldn’t have prevented it. There was no point in blaming myself for something so clearly out of my control. It simply led to self-loathing, which would absolutely not contribute to my healing.

BARGAINING

Despite how it sounds, I’m a fairly rational person so I didn’t do a whole lot of bargaining with God. Sure, I wished my circumstances were different. I wondered how my early twenties would’ve gone without colonoscopies, steroid moon-face, and the burden of chronic illness. But I didn’t see much sense in dwelling on what could’ve been because it wasn’t my reality. For me, there was no other way, and while I prayed vehemently for full and total healing, I didn’t make foolish promises to read my Bible three times a day if God healed me. I usually just defaulted back to anger at the reality of my reality.

DEPRESSION

While I never walked in any kind of clinically diagnosed depression, I was no stranger to dark nights of the soul. Thankfully, I was surrounded by family and friends who wouldn’t allow me to succumb to the darkness in those difficult times, although I know for some people its inevitable. I did have days when I figured what was the point in getting out of bed as I would simply be tired again in an hour. And like anyone dealing with a relentless trial, you grow fatigued of battling your own thoughts and emotions.

About three years into my disease, I went through a very dark time when I was taking Imuran before I started Remicade. I was tired of feeling tired and done with being sick all the time. The Imuran made me continually nauseated and I felt like I was ingesting poison. I had experienced flare after flare with only a few months of Prednisone-induced relief between them. I was fed up physically and spiritually. In all honesty, I toyed with the idea of ignoring God, giving up. In the midst of my anger, I didn’t see Him working for my good, only allowing me more pain. After believing in God my entire life, knowing his goodness despite my feeble, human understanding, I was close to abandoning Him. With anger intermingled with sadness, I felt very hopeless in the face of my future.

ACCEPTANCE

After all of that, you were ready for me to get to the good part, huh? The good did come and I don’t think I would’ve appreciated it as fully without walking through the previous stages. I had to comprehend, digest, and process through my grief before I could come to the other side of freedom. Walking through the middle was horribly painful and an experience I would gladly trade for happier days. But it has made me who I am, taught me who I could be. Apparently God didn’t intend for me have the comparative ease of other twenty-somethings. But He gave me a ministry through it and a way to encourage others in the process.

After struggling against God for months, seething in anger, resentment and entitlement, I came to a profoundly simple realization that liberated me from my hatred. God must know something I don’t. None of us can control our lives, although we would like to imagine we can. Despite your religion or worldview, you can see that events are out of our hands whether that’s a cancer diagnosis, a car wreck or a natural disaster. In my case, I saw it through my religion again and left all my questions on the table. The questions still remained unanswered but I was able to see past them, to understand that if I trusted God to be good and faithful to me, then I didn’t need to peek under the table for the answers. I simply needed to trust Him. He knew something I didn’t.

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Another method of my healing and acceptance was meeting and marrying my husband. While I had always had very supportive parents and friends, it couldn’t compare with a spouse who knew all of my weaknesses and willingly took them on himself also. For more detail into our marriage read this post “In Sickness and In Health.” Once we were married, I truly had a partner, a man who would cook food for me, encourage me to eat according to my diets and remind me of God’s plan. Now, when I cycle back through a period of anger or depression, he’s there to softly soothe me out of it and remind me of truth. When I go through phases of extreme and unhealthy fear over lack of control, he keeps me grounded. And when I experience great triumph and encouragement, he celebrates with me.

I’ve come a long way from the days crying alone in my apartment. A long way from relying solely on steroids to get me through the day. A long way from the confusion and self-centeredness of those early years. It didn’t come easily or quickly, but my emotional relief did come in time. No matter what trial you find yourself limping through, it’s a process and one that might not seem logical or intuitive at times. Don’t get discouraged when you find yourself back a few steps, wallowing yet again in self-pity or entitlement. There’s always something else to hope for in the process of healing. Even for me, I don’t expect to stay in “acceptance” forever but I hope that having gone through it all before, I will have a greater understanding of the experience next time.

There’s a reason why I didn’t title this post “stages of grief,” but rather “stages of transformation.” Rather than looking at it all through a negative lens, I would prefer to view it as a step to something greater: greater understanding of your condition, of yourself, or of God.

Do you have a story of your stages of transformation? Send it to me at thirtyeightfive@gmail.com

Recipe: Adult Mango Slush

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For a long time after my diagnosis I didn’t drink any alcohol. With my system in such a fragile state, I couldn’t tolerate anything as vicious and unforgiving as alcohol, a common irritant for many people with or without disease. Because of my intestinal candidiasis, wine and beer became my mortal enemies, causing me intense GI issues, and I still avoid them mostly to this day out of fear of the horrible repercussions. Now that I’ve experienced a great degree of healing, I can tolerate small amounts of vodka from time to time as long as I’m careful to pay attention to my body. If I’m feeling particularly stressed or tired, it’s probably not the right time to overload my system with an irritant.

Seth invented this mango slush so I wouldn’t feel quite so left out when we went to social gatherings with friends and it’s become a popular favorite in our group. And with the honey/salt rim, it makes you feel like you’re at a Mexican food restaurant partaking in all kinds of gut-destroying foods just like everyone else. In reality, I’m just jealous. Enjoy those flour tortillas.

If you’ve had trouble imbibing alcohol due to IBD or gut issues, take it easy. Introducing alcohol can be a rough process and some people find they can’t tolerate it at all. If that’s you, leave the alcohol out of it. While this drink is packed with natural sugar, it’s void of any additives or refined sugars that cause symptoms for many. If you’re trying to avoid natural sugars for a period of time like the 21day sugar detox, put it on your calendar to make for a later date. But if you’re starting to journey back into the land of adult drinks and want a treat, start squeezing some fresh limes.

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Adult Mango Slush

What You Need:

  • 4 oz of vodka (preferably a nicer brand with good quality)
  • 2 cups of frozen organic mango chunks
  • 1 cup of ice
  • 1/4 cup club soda or La Croix lime sparkling soda
  • 1 tablespoon honey or maple syrup
  • 1/4 cup freshly squeezed lime juice
  • Honey and sea salt for the rim

How To Make It:

  • Combine all the drink ingredients, excluding rim ingredients, in a high-speed blender and blend until smooth.
  • Pour a thin layer of honey in a small (cup sized) rimmed dish. Do the same with the sea salt. Slowly spin the rim of the glass in the honey being careful only to coat the glass with a small thin line. Spin the honey rim in the salt to coat.
  • Garnish with a lime on the side.

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Cookbook Review: The Autoimmune Paleo Cookbook

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Over the past several weeks I’ve had the privilege of reviewing Mickey Trescott’s first print cookbook entitled The Autoimmune Paleo Cookbook! It was released in April of this year (2014) and has already gotten a huge amount of love and publicity from autoimmune protocol followers. If you’re not familiar with or want more information about Autoimmune Paleo/Autoimmune Protocol, see this post or check out ThePaleoMom. Since Autoimmune Paleo is a relatively new method of healing for those with autoimmune conditions, there are only a limited amount of resources at this time. Unfortunately and fortunately, with the rapid increase in autoimmune diseases, I’m sure it will only become more popular.

The startling increase of disease in the United States, especially of the autoimmune variety, has prompted both healthy and sick people to investigate the causes of and treatments for such conditions. While there’s a mountain of work left to be done, much of the information points to problems with our diet. The standard American diet, which includes processed, chemically-altered, and genetically-modified foods thrives on unnatural ingredients which our bodies aren’t able to process adequately. While some people tolerate this way of eating for a lifetime without developing a specific autoimmune condition, an overwhelming number of people suffer from chronic conditions like diabetes, heart disease, and high blood pressure. All of these conditions are likely and probably linked to the destruction of a whole food diet and a replacement of convenience foods that not only lack nutritional value but add dangerous chemicals.

By relentlessly barraging our systems with toxins and not providing the necessary healing nutrients our bodies need, we have effectively put ourselves in a tough position. Disease is on the rise along with medical costs and societal burden, and it’s only going to get worse. But people aren’t just standing by to watch. They are taking action.

After being diagnosed with an autoimmune condition herself and finding little relief through available treatments, Mickey Trescott decided it was time to try another, less traveled route to healing. She started by completely cutting out all foods that could instigate an immune overreaction and replacing them with nutrient-dense, organic whole foods. Through her creative and nutritious recipes, she has gained quite a following and has been a great source of encouragement for many combating an autoimmune disease. Check out her website here.

The sole fact that her cookbook exists in an encouragement to me. When I did my first round of Autoimmune Paleo, I struggled immensely, not having adequate resources or recipes to help me through such a restricted diet. I wasn’t familiar with many of the ingredients and balked at the thought of eating a chicken liver (still do sometimes). After some investigating, I found her blog as well as the Paleo Mom and I’ve learned an incredible amount since then about how to eat in a way that heals my body.

In her book, Mickey presents an array of recipes with an accompanying difficulty level for all types of chefs. Some of the simple recipes like Rosemary Grilled Asparagus are delicious and take only a few minutes. Others require more preparation like the Orange Rosemary Duck, but you end up with a fantastic meal that your friends would hardly recognize as “healthy.” From the novice to the expert, there are feasible options that use only the best ingredients and common kitchen techniques. I tried to make a mix of both simple and more extensive recipes and found the instructions clear and straightforward, and the results perfect. It can be difficult to come up with recipes with such restricted ingredients but Mickey has managed to  put a wholesome flair on even the most simple vegetables.

Along with gorgeous photography and tasty recipes, Mickey provides background on autoimmune disease and the Autoimmune Protocol as well as resources to help you through the diet. With meal plans, shopping guides, references, and recommendations for stocking your kitchen, she sets you up for success. I would recommend reading the entire front sections before plowing into the recipes because you don’t want to miss the plethora of good information to help you get started. Here are some of my favorites (photos are mine):

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Nectarine, Arugula, and Prosciutto Wraps

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Coconut Creme Bowls

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Citrus Spinach Salad with Citrus-Avocado Dressing

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Cinnamon-Scented Butternut Squash

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Garlic-Sage Chicken Patties

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Rainbow Roasted Root Vegetables

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Fig Energy Bites

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Cauliflower “Fried Rice” with Garlic Beef and Broccoli (with carrots)

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Olive Tapenade

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Apple-Cranberry Crumble (I did golden raisins instead of cranberries)

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“Spaghetti” and Meatballs

If all those photos of delectable food and the hope of healing your body doesn’t make you more interested in this cookbook, then I don’t know what will! You can purchase it on Amazon here. Even though you may be intimidated or overwhelmed, take the next step towards healing and know you’re not alone. There are wonderful people out there, like Mickey Trescott, who have set you up to be prepared. And the bonus? It’s a wonderfully delicious process.

To view even more tasty photos, follow me on Instagram with the hashtag #weekwithmickey!

In Sickness and In Health- Part Two

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To see “In Sickness and In Health” Part One, click here

In the eyes of our culture, marriage becomes less romantic after the wedding. You can observe this clearly in any movie about a relationship. Everyone gushes over the romance during a courtship and leading up to a proposal. People relish the thoughtful gestures, the drama of unrequited love and the glory of resolution as the main characters walk down the aisle. The movie ends with the beginning of the marriage because it’s an unspoken understanding that after the ceremony, the relationship is less interesting. There’s something inherently alluring about the dangling question of “will they fall in love?” and without that suspense, there’s not much left to tell.

And after the wedding, once they’ve committed, the romance dissolves. When you watch movies about post-honeymoon married couples, they often focus on comic moments of discord, poking fun at the monotony that seems to become marriage. It’s all farting and fights and negotiating nights without the kids to relive glory days with old drinking buddies. They exchange tender, loving words for shouted commands about dishes and taking kids to soccer practice. To our culture, marriage is no longer romantic but realistic, abandoning all notion of meaningful affection for the sake of sheer duty and responsibility. In many movies, even those noble virtues go lacking as spouses abandon each other for someone new and exciting. Return to the allure of an unexplored romance. The cycle begins again.

I venture to say that I both agree and disagree with our culture’s notion of marriage and I will attempt to explain my thoughts based on my wise sage experience of almost two years. Before you completely dismiss me, hear me out.

On one hand, once you’re married, you won’t experience the same thrill that you did the first time you kissed your spouse. You can’t completely recreate the feeling that you experienced when you first heard the words “I love you” from their lips. You do become accustomed to that person because you live with them. That’s not too hard to comprehend because it’s human nature. To be truthful, there is some relaxation of the heightened sense of drama as you settle into a routine. But movie directors don’t focus on those moments because while routine is relaxing in real life, it’s bad for ticket sales. We are a people that thrive on conflict, the very attribute that we strive against in a Christian marriage.

However, in exchange for the continual thrill of newness, you get the comfort of security. You’re no longer left wondering if you said the right thing or wore the right outfit or ordered the right entree at dinner. You abandon all those foolish concerns for the safety of being known. You can look horrible, stay in your pajamas all day and know without a doubt that your spouse loves you unconditionally. You can get angry, spout off a series of mean remarks and later apologize genuinely, knowing he’s not going to break up with you. For me, I know that no matter how sick I get, how little I can help in the responsibilities of our life, or how little I can offer to our marriage at a certain time, Seth isn’t going anywhere. Despite any route my disease takes, whether that leaves me chronically sick or triumphantly healthy, I don’t have to worry about his constancy. There’s a level of commitment in marriage that makes up for the adolescent sense of adventure.

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Concurrently, it’s important to maintain, search for, and create that sense of romance in your marriage. Like anything, if you don’t put any effort into it, you won’t get much out of it. If you never told your best friend you wanted to hang out with them, never planned anything fun to do, and never made time for them- you wouldn’t be best friends for long. Since you’re already committed, you have to take joy in “planning romance” for your spouse as unromantic as that may sound. You find ways to serve and love them because you want them to know you cherish them out of joy, not just out of covenantal duty.

Dont’ hear me saying that marriage isn’t fun anymore or I still don’t get butterflies from time to time. Sometimes for no reason, I feel my heart jump when he walks in the door or I get excited when I see him calling me on the phone. Whether its waking up to a love letter on my birthday or coming home to find out that he’s cleaned the entire house while I was at work on a Saturday, I still am very much in love with my husband. He’s intentional with finding ways to surprise me and going overboard for a birthday or anniversary. He knows how to make me feel loved in both practical and romantic ways. And I don’t think that will change no matter how old we get or how long we’ve been married. It’s a pattern, a routine that we both very much enjoy.

And while romance looks differently during a busy work week or with two toddlers running around the house, it’s still there, or at least it should be. God calls us to cherish and love our spouses. There’s a whole book of the Bible dedicated to proclaiming the glory and joy of married love. There’s no such book about the events in dating. This obsession with pre-marital drama is a cultural fabrication, not necessarily one instituted by God.

Seth and I are close enough to both scenarios, straddling the line of being married just longer than we were ever dating or friends. After four years of relationship (two dating/engaged and two married) I agree that our marriage doesn’t look the same but I’m glad. We’ve abandoned some of the petty things we used to fight about and we’ve both learned a great deal about how to love and care for each other. I don’t operate the same way as I did three weeks into marriage. I don’t have to because I know Seth more intimately.

We still go on date nights, although we are usually in bed before eleven now like the old people we are rapidly becoming. He still writes me notes telling me how much he loves me and I still make him his favorite waffles when he’s sick. We do argue from time to time but it’s not comic. It’s hurtful and I hate it. It’s not nearly as funny in real life when you understand the weight of your foolish, selfish words on your spouse. Now, I seek to apologize early and return to a state of peace, the place we operate best in.

I disagree that romance dies once you get married, but it takes effort on both sides to help it transition through the various phases of your life. I agree that romance changes shape depending on current circumstances and there’s a lack of drama that used to exist prior to marriage. But there’s a deeper level of understanding, commitment, and freedom that you experience as you grow in marriage. It’s a hefty undertaking but one very well worth the time and effort.

While I got many kind words from readers of the first “In Sickness and In Health” post, I want you to know that this post, the one about love post-marriage, is just as genuine, important, and romantic. Don’t buy into the lie that everything is downhill after a proposal and also don’t bank on carrying that level of excitement from day-to-day. But do honor God by honoring your spouse and seeking to love them as best as you can.

I love Seth more today than I did yesterday and I hope it continues that way for the next fifty years.

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