Where Do I Start?

So just where do you begin when you decide to revamp your whole life?

People ask me all the time how to begin a diet and lifestyle change, motivated either by medical issues or just a general desire to improve their health. With all the conflicting information out there (how many fad diets have we seen in the ebb and flow?) it can be very difficult to decide which direction to go. With all the available options, how do you know what to throw your time, money and effort into? And when you have specific medical issues it makes the situation even more complicated. I’m not promising all the answers and my speciality is with gastrointestinal and autoimmune disease but hopefully this provides you with a starting point for navigating a new lifestyle change.


Grain-free homemade maple donuts- recipe from Againstallgrain

Step 1: What is motivating your desire to change?

If you simply want to take a healthier step in the right direction and you aren’t experiencing any specific symptoms, I would recommend starting with a Whole 30. (Click on the link for my summary and the specifics). Whole 30 is a program intended to jumpstart you towards cleaner eating for 30 days (you have to stick to the rules!) After the initial round, you can decide if you feel better, need to make any changes, and if this new way of eating can become a consistent part of your life. And let’s be honest, 30 days is not a huge commitment and I promise you’ll feel better because of it.

If you’ve done a Whole 30 or want to move towards a more consistent and/or permanent health lifestyle, I would recommend a Paleo diet which excludes processed foods, refined sugars, grains, and dairy along with a few other no-no’s. Primal is also a good option and it means Paleo plus raw, organic dairy products (because who can live without cheese forever?) and the yes and no’s are similar to Whole 30.

To jump on top of my soap box for a second, I believe everyone should eat a Paleo or Primal diet as a way of life regardless of whether you have a medical issue or not. To those of you who are perfectly healthy: I’m not saying you can’t go out to your favorite Mexican food restaurant and order enchiladas every once in a blue moon. But I believe it’s truly the best way to eat so that your body can function properly and prevent chronic diseases. Try cooking some of the amazing recipes before you judge. Eating Paleo is extremely delicious.


Step 2: You’ve got a diagnosis…now what? Do your research.

If you have a chronic disease or you’re having symptoms, it gets a bit trickier and I hate to say it but you’ll have to experiment. Trial and error is the only way you’ll figure out what works specifically for you AND your needs may change with time. What works for a period of time may suddenly not be enough or you may experience so much healing with a diet that you may be able to add foods back in after time. I’ve followed all of the healing diets at one point or another to help with my disease. (I use the word “diet” to describe a sustainable way of eating, not a temporary attempt at shedding weight or a binge approach. We’re talking health here, not vanity.) Be encouraged that there are a plethora of diet approaches out there that can help ameliorate your issues!

First, consult your healthcare provider. Now I’m a nurse but I can’t talk to every person to determine exactly how you’re feeling or make medical recommendations. I can simply offer my understanding and the expertise I’ve gained over time (and a lot of experimentation!). That being said, I think I can steer you in the right direction. There are certain diet approaches that have been found to help specific diseases so do your research if you have a diagnosis. Unfortunately many mainstream healthcare professionals neglect the diet component of a disease so you may have to sleuth it out yourself (probably why you’re reading this blog). The only reason I even started looking into dietary approaches for healing my UC years ago was because a friend told me about it! Use google as your friend but do it cautiously (and read the rest of this post first to give you some guidance).

There is some good news, especially for those of you short on time or effort. Regardless of your disease, cutting out processed foods and refined sugar helps everyone, even those people who think they’re perfectly fine. So if you want to make a change today, this instant, start with ditching the boxed/bagged/canned/drive-through foods and opt for raw, fresh, organic ingredients and hormone-free meats instead.

Over the past six years since my diagnosis of Ulcerative Colitis, a gastrointestinal autoimmune disease, I’ve tried almost every diet approach out there. I’ve been in remission for almost three years now due to a combination of my medications and diet changes. In the beginning I hoped that I could control my disease without making such a drastic change to my life- like changing my diet and learning to cook. But now I’m thankful for all that I’ve learned and even if I didn’t have a medical condition I would still advocate eating Paleo! Go figure.

DSC_1264Italian sausage, spinach and pear pizza on a grain-free, almond flour crust

3. Take the plunge and pick a dietary approach!

I’m going to highlight three major eating strategies out there for disease, specifically autoimmune disease (AI). Here’s the thing about medical conditions: many diseases and disorders have an autoimmune component, even ones that you wouldn’t expect. So even if you don’t have an overt autoimmune reaction or pathology, I would still suggest trying the following approaches. Diseases have a funny way of shifting and changing over time, aka they’re not static.

Some notes on autoimmune disease: every AI disease presents differently. No two people will have exactly the same symptoms on the same timeline that respond to the same treatments. If it worked that way, it would be much easier to diagnose and treat. Autoimmune diseases are often insidious and vague, meaning many people wait a long time for a diagnosis or they develop another autoimmune component later on. Remember what I said about trial and error? It pretty much applies to the rest of your life but I promise once you familiarize yourself with the diet approaches it will get much easier.

I’m not going to go into detail on the three diets because I have separate pages that go into more depth for each one but here are the three I would recommend checking out and starting with:

The Specific Carbohydrate Diet

The Paleo Diet

Autoimmune Paleo

A note on Autoimmune Paleo: as this is the most restricted of the three diets, most people don’t have to start here and I wouldn’t recommend it unless your provider specifically told you to. It eliminates MANY foods and you may get too discouraged to keep going, especially if this is all new to you. If you find that cutting out certain foods or following a Paleo diet doesn’t eliminate all your symptoms, then take the next step and try the autoimmune protocol. I tried it for a short time to see if I felt any better and when I discovered that I didn’t react to any of the off-limits foods, I went back to regular Paleo and now a primal diet that includes raw organic cheese.

As you investigate each diet, hopefully one will strike you as feasible and you can get started. Check out my resources page for specific books, cookbooks, and blogs.


Raw cocoa butter protein balls from my blog

Step 4: Be prepared to be flexible.

Overhauling your diet is neither a piece of cake, nor is it impossible. YOU CAN DO IT! And you have to start with a mindset of determination but adaptability. Not every recipe will turn out to be a tasty explosion of flavor. In fact, in the beginning, your attempts may be well-intentioned but disastrous and don’t get your feelings hurt if you family turns up their noses to a “healthy” dish. Cooking is an acquired skill for most people but fortunately because it has specific rules and steps, you have a fighting chance at succeeding. Don’t give up on yourself and stick with it. If you don’t go all in, you might surrender because it will be challenging, especially in the beginning.

You have to set aside time and effort to make it happen. Did you hear me? You have to set aside time and effort to make it happen. Unless you have a million dollars and can hire a personal chef to cook you all delectable Paleo meals, you’re going to find yourself in the kitchen trenches with the rest of us as we peel, broil, and sauté our dinners. I can’t reiterate this enough because in our fast-paced world, people just want things to happen immediately and easily. Guess what? Your body is a disaster, messed up from your disease, but there is a way to improve it and it lies in your kitchen. Don’t miss the goodness of this truth: that changing your diet is a needle-free way of healing yourself (hopefully to a great degree). Try to see this new lifestyle change as a fun adventure or hobby that will require more of your time, rather than an arduous task.

Some cooking tips: try batch cooking at the beginning of the week so that you’re not having to invent a new meal every night. Leftovers will be your new best friend. Experiment with a meal plan from a blogger you like or at least plan out your meals ahead of time so you’re not scrambling to the grocery store at the last-minute in a desperate search for something random like coconut aminos (it won’t be so random once you get familiar with Paleo cooking. Aminos are the culinary bomb). Cook with a spouse or child or if you live alone, invite friends over to share in your “fun”. Cooking for one can be very difficult because you end up eating the same thing meal after meal plus you’re stuck with a mountain of dishes to do, which is the last thing you want after you’ve destroyed the kitchen trying to make something edible. Sequester some unknowing help in the form of a friend, turn on some music, and make it fun. Read through the recipe before you make it! Not going to lie, I still fall short on this one and pay for it in the form of eating way too late and doing dishes at 10pm at night, taking out my frustration on the endless tiny pieces of the food processor. Learn from my mistakes; a little amount of preparation will prevent you from ending up with abused kitchen appliances.

Some notes on starting a dietary approach: I won’t sugar-coat it for you. The beginning is the worst. My husband and I had many frustrated evenings as we tried to find something I could tolerate to eat when I first started with the SCD diet. Also, you may experience additional or different symptoms. When you cut out all the carbohydrates or processed foods and eat only clean foods, you may experience a reaction. In other words, it will probably get worse (sometimes much worse) before it gets better. Don’t be alarmed; this is normal. You may experience a “die-off” reaction as the bad bacteria that were thriving in your gut die when you starve them of their food source (carbs, sugar, starches). I experienced this to a horrifying degree with hives over my entire body for five days as the leftover toxins from the dead bacteria came out through my skin (sounds like a horror movie, right?). Hopefully you won’t have to spend a week in bed like I did but I need you to understand how dramatic it CAN be for some people.

A note for cheaters: yes, you know who you are. Let me enlighten you. In the beginning of any of these diets if you are trying to relieve symptoms or help your disease you have to take an oath not to cheat. Because every time you do, with every bite of off-limit food that enters your mouth, you are shooting yourself in the foot. In order to heal, you have to completely abstain from the bad foods and give your body time to recover. I’m not making this up to torcher you; its medical fact. Even one bite can hinder weeks or months of hard-earned progress. It’s all about restoring that healthy bacteria in your gut, or gut balance. So weigh your fork carefully.

A note on timing: everyone is different in the amount of time it takes them to achieve some normalcy depending on your specific disease etc so I can only tell you what I’ve experienced. It took us a full year of eating absolutely nothing bad (no eating out, cooking all our meals) before I started to feel intact again. Prior to starting Paleo, even my super strong medication wasn’t cutting it but after a year on the diet, I was officially in remission and have stayed in remission ever since!


Mint chocolate dairy-free ice cream pies from The Spunky Coconut

5. Give yourself a break.

You aren’t perfect and you will fail. We have all been there and while that’s not an excuse to fall off the wagon completely, we understand. If you’re already sick, you’re probably managing medications and doctors appointments and trying to not get fired from your job. You’re trying to take care of your family and your kids on a minimal energy level. Let me reassure you: it will get better. The LAST thing you need in the midst of all this change is added stress so let yourself off the hook every once and while for annoying social events or working out or cleaning out that brimming closet. Those things can wait, and you need to focus on your priority: healing, so that you can keep taking care of those around you.

Feel free to leave your questions in the comments and I’ll add to this post over time. Also email me if you have a specific question or one you don’t want to share publicly. I hope this helps!

A Different Kind of Life: A Letter to my Daughter

I’ve been watching a whole lot of Netflix lately (as all new moms should) and I recently watched a documentary entitled Fed Up about many of the problems with the American food industry. As you know, one of my passions is a return to whole real food, not the manufactured junk that permeates every aspect of our society. While I started watching the film somewhat passively as I ran around doing other things, I ended as a devoted fan applauding it in my living room and rewinding (do we still use that word?) to make my husband watch certain parts. The main reason I loved it (not that I can say I absolutely endorse every word so take it with a grain of salt) is that it highlights many truths my husband and I have learned about returning to real food such as the idea that sugar is the evil one, not natural fats, and that processed foods are literally killing our nation. I won’t go into more detail because I want to encourage you to watch it for yourself but it sparked even more thoughts about my new daughter and how her life will be affected by this culinary culture. It’s funny how you start to ponder some issues in greater depth once you realize that you’re responsible for teaching and feeding a tiny human and that she will live on this earth much longer than you will. So I decided to write her a letter and share it with you. I hope this pushes you to examine your diet for yourself and your family.  Enjoy.


Dear precious girl,

You are just over ten pounds now. You’re tiny and beautiful and growing before my eyes everyday. You completely amaze me in every way and I want so much to protect you from anything that could hurt you. That’s why I’m going to explain to you why I am choosing to raise you a certain way, away from processed foods and sugar. And hopefully you don’t have to go to counseling as an adult because of our seemingly radical ways.

Right now I control everything you eat as you nurse. It’s our team effort and I’m doing my part to ensure you get the best secondhand food possible. But one day, sooner rather than later I fear, you will be old enough and independent enough to make your own choices. You will be able to choose candy or fruit, vegetables or cookies and frozen pizza over whatever Paleo meal I’m trying to get you to eat at home (zucchini noodles are just like real noodles! wink, wink.). And I want to teach you and help you make good choices, not in a totalitarian way, but in a way that leads to freedom. I want you to want the apple and I’m shamelessly going to try to condition you into it.

First of all, I want you to understand that there is a place in this world for Halloween candy. And it exists in a few pieces on Halloween night, not in a massive over-indulgence that leaves us awake all night as you puke it all up. I apologize in advance for being the mom who carefully manipulates you into “trading” your remaining candy for a toy or even a book (I know, your mom is a nerd). You won’t realize my persuasions at first but then you’ll catch on and get angry about it probably. Sorry, tough cookies, so to speak. I’m also sorry that you won’t be getting candy at the register when we check out at Target, regardless of how much you kick and scream. I’m sorry that we won’t be the family who buys the super size pack of those crappy fruit snacks that they market as “all natural.” I’m sorry that you won’t try Velveeta crack-cocaine delicious Mac n’ Cheese at our house. Gosh, I really am sorry about that one.

Before you go pack your tiny nugget suitcase and head on down the block to find a normal family, I’ll reassure you that I’m not going to be a dictator mom who has a panic attack if you come home with sticky lollypop hands (…sneaky…). I’m sure there will come a point when you eat cupcakes at someone’s birthday party or go get donuts with your dad on a Saturday morning. Dad has veto power on donut day that even I can’t supersede. Besides if there’s anything I’ve learned thus far in having you, it’s that I can’t control everything and I’ll go crazy if I try. As long as you’re physically able, there will be the occasional cheat days and birthdays and surprise desserts. The last thing I want is years of grown-up resentment built out of sour patch kids and Snickers bars.

Try to see the bigger picture. Try to understand my rationale here. I pray that you don’t inherit my gastrointestinal issues or my dietary restrictions. Ironically, I want nothing more than you to be able to eat whatever you want from a medical standpoint! I don’t want you to have to go through the trials I’ve been through or develop problems complicated by a sugary diet. I pray you don’t have to memorize words like “gluten-free” or “Paleo diet” before you go to preschool and that I don’t have to call every mom before you go to a sleep-over. I hope I don’t, but you know I would do it. I would do anything for you. In short, I want you to benefit from my struggles.

But even if you are as healthy as I hope and pray, just because you can doesn’t mean you should. (I think that adage applies to so much in life. Ah, you’re so lucky to have such a wise mom). And I want to help keep you healthy and safe; to help protect you from substances that will slowly eat away at those around you. Instead I hope you end up like your aunt who would eat a huge tomato like an apple for a snack as a child. And I will continue to uphold the truth that our homemade food is far more delicious than anything you can get in a drive-through!

But more than any of those decisions, ones that hopefully you will understand and appreciate one day, I’m sorry that you have to grow up in a culture that is enticing you with bad choices at every opportunity. In a country that is literally brimming with overabundance, real food is rare and hard to find. You’re going to be so inundated with processed food propaganda that you won’t even realize the brainwashing is happening. Don’t be fooled. You won’t be happier if you have a sugary drink over water. Well, maybe you will be in the moment but not in the long term. You can’t see it when you’re tweaking for sugar but that’s why I have long-range super mom vision that helps me see beyond the marshmallow in front of you. I apologize that most companies in America are not looking out for your health but only for your patronage (my patronage). They are quite deceiving and their ploys work on most people. You’re just a little person who likes bright colors and sweet tastes and they prey on those attributes.

Another major problem is that the food industries as well as other influences have made real food extremely expensive and many people find a discrepancy in what they desire to eat and how much they can afford. For example, we make sacrifices in other areas of our budget in order to purchase the pricer items like organic produce so that you don’t get those toxins. When several packages of processed noodles are cheaper than a stem of organic broccoli, it’s hard for many people to pass up those savings and I want you to understand why eating this way is difficult for most.

Some of your friends and their families will follow the processed food way of eating for several reasons. Maybe it’s a lack of knowledge or a disagreement on dietary approaches or financial constrains, so let’s not judge. Our family will do what we think is best and are open to discussing it with others should they ask or be interested. There will always be people who don’t agree and that’s perfectly okay.

I’m just doing my best with the information I currently have to help you grow into a strong, vivacious little girl, just like my parents did for me. I hope a lightbulb of understanding passes over you one day and you realize the sacrifices we made for you including hours in the kitchen and a brimming food budget. You’re worth it! I think you will grow up to love healthy food and cooking that healthy food. In a few years, we’ll be making almond flour cookies on after-school afternoons, just like my mother and I did, and we’ll treasure those sweet memories as both a happy and healthy family.


Your mom

Newborn photography by Caroline Jurgensen

I Couldn’t Have Known

It’s been seven weeks now and I’m finally getting a few minutes to throw down a blog post. Thanks for your patience :) Also, enjoy our newborn photos by the amazing Caroline Jurgensen! www.carolinejurgensen.com


I would guess that most people walk into the process of having a baby with a load of expectations however realistic or completely absurd they might be- from what to expect in labor to how to sleep train your nocturnal infant. I know I did, and I got a quick education.

There are assumptions regarding pregnancy, the birthing process itself and a million and one expectations about life with a baby and how to raise said baby. Simply as a human, people expect you to have very basic, life-sustaining instincts that indicate that you are fit to parent a child, like responding to your crying infant and recognizing their need to be fed. As a nurse, people expect far more from you in this arena, even when you don’t work in a specialty related to labor and delivery or babies. They assume you know about zones of jaundice or how to take a sitz bath or what an Apgar score indicates. On one hand, this commonality is extremely helpful because you can use words like “hematocrit” with each other and you’re all on the same page, communicating in your universal medical language. On the other hand, I had to stop midwives, nurses, and physicians mid-sentence, gladly forfeiting any pretense of possessing any baby knowledge, to simply state that I had no idea what they were talking about. My expectations surprised even me because, as it turns out, there are many unexpecteds and unforeseens in the process of bringing a human into the world and honestly, many of them make for a pretty good laugh.

Despite all the TV show reenactments I had ever seen and the few live births I had observed in nursing school, I had some misconceptions about the whole ordeal. To start with something apparently obvious to everyone else, who knew pushing would be that strenuous even with an epidural? In my pregnant naïveté I thought that pushing with an epidural would be more of a spectator sport than a desperate sprint requiring every ounce of available energy for hours on end. In a slightly exaggerated mental picture, I saw myself joking around with the doctors while holding a mock tail with perfect hair and makeup rather than puffing up like a balloon and gripping the bed rails as my epidural inconveniently wore off as I approached the finish line. I didn’t expect the feeling of someone pulling all my guts out as the doctor slid my daughter out or being exposed to a room chock full of strangers and having absolutely no inhibition about it. I also didn’t expect the word “episiotomy” to be my new least favorite word in the entire dictionary.

I didn’t know how truly valuable a lactation consultant would be after my daughter wouldn’t feed for a very long time in the hospital and I turned into hysterical-nurse-mom calling for a provider to come help me, any provider, over the call system like a crazy person. On that note, I didn’t even know some unfortunate souls (me) had to feed my child with a syringe until she could get the hang of feeding on her own. How many times did I hear people say, “you would think breastfeeding is intuitive but it’s not..” and I couldn’t have understood beforehand. If breastfeeding was an arcade game, I have conquered all the levels- getting past the screaming, hysterical baby, through the maze of nipple shields, across the moat of pumping and finally to the prize of having a healthy, easily latching baby after a lot of hard work. I will wear the gold star of victory proudly for a very long time, and I would very assuredly not be breastfeeding today without the overwhelming attention of my very kind and patient LC. I’m still planning on emailing the CEO of the hospital to give her a raise.

I didn’t realize that I wouldn’t just immediately bounce back from the trauma of pushing out a bowling ball (much to the amusement of everyone else who knew better than I did). I needed rest and physical help too, not just an extra hand with changing newborn diapers. I didn’t expect that FMLA paperwork would become a form of cruel and unusual punishment- no new mother should have to shuffle through the mounds of confusing paperwork on literally no sleep.


I didn’t expect that I would literally want to throw the sleep training book in the trash everyday (and still do most days) as I realized very quickly how little control I have over a brand new baby. On that note, I didn’t realize that sleep training is a whole set of elaborate theories and strategies that takes a new mother hours to shuffle through and requires more attention than she can muster, only leading to the very logical and annoyingly obvious conclusion that you have to do whatever YOU think works for YOUR child. (I am a fan of sleep training, just not when you’re exhausted and feel completely inadequate as your child wakes up for the third time during the night.)

I couldn’t have predicted the amount of googling I would do for everything from “newborn rash” to “images of normal baby poop” to “why did Netflix change the theme song to Parenthood” simply because I had gone crazy at three in the morning. Although I pray often, I had no idea how many “Hail Mary” prayers I would throw out in one day, for her to latch on or sleep or stay asleep, and how many God would answer just when I thought I couldn’t take it one more minute. Despite all my years in the grit of blood and guts in the trauma ICU, I didn’t know I would freak out the first time she vomited on me, yelling for Seth as it slid down my hair and calling my mother to ask if she was ok. Yes, that one is a little embarrassing and a lot funny.

But the most significant of all the surprises came at everyone’s favorite moment. Despite all the times I had imagined seeing my child for the first time, I never could have expected how truly awe-struck I would be to meet our daughter. Although we didn’t find out the sex beforehand, I knew in my gut that “it” was a “she”. I talked to her during my pregnancy about all kinds of girly things, singing Taylor Swift and explaining the intricacies of nail polish, and would’ve been completely surprised if she had come out a boy. Instead all I could say was, “I knew you were in there!” Before I knew what was going on there was a blue screaming human baby lying across my chest and I was forever changed.

I didn’t expect that I would think about her all the time, even just in the back of my mind, no matter what I was doing or where I was. I didn’t expect that despite the extreme exhaustion of these first few weeks and the epic battles getting her to go to sleep, that I would miss her when she was finally down in her crib. I couldn’t have predicted how truly amazed I would be as she attempts something so simple like lifting her own head, yet for her that’s a huge accomplishment and we celebrate it as such! I didn’t know how much I would enjoy watching her learn about the world, start to track faces and objects, and respond to colors. And how I would cry happy, overjoyed tears the first time she smiled at me, knowing me as her mother.


I didn’t realize that I could love my husband with a different kind of depth, one that I couldn’t access before, and that it would make my heart ache with affection and appreciation for him. In all my pushing I don’t think I looked at him once but I heard every word he said, every encouragement to push harder or breathe longer. During my four day hospital stay, I didn’t change one diaper as Seth eagerly jumped at every opportunity, wanting me to stay in bed if I was hurting or tired. With every ounce of remaining attention after sleepless nights, he listened closely as the lactation consultant helped us learn how to breastfeed our daughter. He got me ice chips. He told me I had done a great job. He still tells me everyday what a great job I’m doing. As we continue to adjust to life with a baby, he gets up early to take her so I can get an hour more of sleep without hearing her fuss. He comes home from a long day at work and cooks dinner with a smile on his face as he struggles to keep his eyes open. Although my husband has always been a selfless and generous man, he has exceeded every expectation of a new dad and I’m not surprised at all. In the end it will always be him and me, and she gets to join in on the fun.

We are a family of three now and I didn’t expect how challenging or how fun it would be. My priorities are rearranged and I love the new normal even when it means I don’t brush my teeth until 3pm. There are many things I didn’t expect but even more joys I couldn’t have anticipated and I’m so thankful as these blessings continue to unfold before my eyes through a tiny human who I call my own.


Pregnancy and Paleo: Third Trimester


With only three weeks left until my due date we are in full baby swing! We’ve taken photos, found a pediatrician and had three amazing baby showers with all the people I love most in life. I’ve been  busy washing adorable tiny clothes, packing my hospital bag and organizing all the infant paraphernalia in our gender-neutral nursery. I’m down to 2 shifts a week for my new part-time schedule and using my extra time to frantically search consumer reports for “best baby swing” or texting mom friends about what I actually need from Babies R Us. It’s been a whirlwind of excitement mixed in with some epic midday naps and some sleepless nights. With all the activity, here’s an update on several aspects of our life right now:

Health/Colitis: Aside from the natural aches and pains of pregnancy (including some truly horrifying intermittent back pain), I’ve had an easy and healthy past nine months. Thankfully, I’ve gone sans complications thus far and my physician expects me to have a perfectly normal labor. Honestly I didn’t anticipate enjoying pregnancy so much and I think I can partially attribute that enjoyment to having few “symptoms” and simply being able to enjoy this little nugget moving around inside of me. With no vomiting, only a few instances of heartburn, and really no swelling yet, I’ve had it easy and I am truly thankful.

In addition, and in keeping with my pregnancy trend, I have had absolutely no colitis complications despite indulging in some foods that I had written off forever. I won’t lie to you- Seth bought me Valentine’s chocolates and we ate the entire box. There have been late-night instances with regular, gluten-filled pizza and Sprite. We have gone places we never thought we would return to in the depths of greasy Mexican food but we’ve tried to keep those encounters rare for several reasons.

First of all, I want to maintain a healthy diet for baby and me simply from a nutritional standpoint. A growing human needs the proper nutrients and despite prenatal vitamins I want to ensure I am giving this baby what it needs to develop correctly and grow adequately. I think any mother would agree.

Second of all, even though I’ve had no outward colitis symptoms, I want to maintain my gut health especially since new moms with autoimmune disease are prone to flares after delivery due to a loss of those protective hormones. We’ve spent years fighting inflammation and restoring my gut balance and I don’t want to ruin all of our hard work. Because I was in remission for about a year prior to getting pregnant, I hope I won’t have a flare but if I do we’ll combat it in the same ways we did before: bone broth, healing foods, and rest. But over the next few weeks I would appreciate your prayers that we are spared a post-delivery flare with a newborn. Because that doesn’t sound fun for anyone.

Thirdly, I am still adamantly ideologically against refined sugars and processed foods. Despite the delicious, fleeting taste, after I eat those foods I still think, “was that really worth it?” I lived and ate quite well without all of those foods prior to pregnancy and we will return to a strict Paleo diet after delivery. I still care about the quality of our ingredients including buying organic, grass-fed meats and organic produce. All of the knowledge I gained over the past several years didn’t just disappear, although pregnancy cravings did throw a non-rational thinking curve ball or two. In short, I’m thankful for this surprise interlude from a super strict diet but I’m just as happy to return to our previous way of eating. I’m not going to throw a temper tantrum because eating healthy can be even more delicious and I sleep better at night knowing that I’m fueling my body with the best of foods.

From a medication standpoint, I am still taking my Lialda daily and getting Remicade infusions. My last infusion was at 32 weeks so I’m scheduled to get my next one the week after the baby is born. Hopefully this will also keep a flare at bay and thankfully all of my medications are safe during both pregnancy and breastfeeding. Because Remicade infusions are not a routine procedure for most people, I am under the care of a high-risk physician but have had absolutely no issues. Again, I’m beyond thankful.


Meal Preparation: Along with a return to strict Paleo will be a return to frequent cooking. With the fatigue of pregnancy, we’ve resorted many a night to an egg scramble with veggies or a simple Crock-pot meal and ironically that’s prepared us to go simple and easy for the next few months. I will not be engaging in a day long affair to make a Paleo banana creme pie and my Instagram account will suffer. But you’ll have to get over it. Most likely it will turn into mom-survival-guide and I’m hoping that people still find that helpful because having a newborn isn’t the only stressful life experience that requires ease and speed.

Since our families know about our dietary restrictions in detail they will be helping us, along with friends and family who have graciously offered to bring us meals post-baby. And if someone brings a dish that’s not Paleo, it’s totally alright because Seth can eat anything; he just chooses to eat Paleo with me because he’s awesome and supportive. At the end of the day, there are plenty of people who are not going to let me starve and I might be too busy to even notice at times :)

I’m in the process now of making a list of casseroles and freezer-friendly foods that I will prepare over the next three weeks. I’m hoping to have a sufficient stash of quick meals and snacks I can take out of the freezer and make with ease. I’ll keep you updated with that list and hopefully I can do another post after delivery to give my recommendations on how to eat a strict diet with the hectic schedule that accompanies a newborn baby.

Over the past few months though we’ve tried some commercial Paleo-approved products out of convenience sake so I’ll share our thoughts. I’m not endorsed by any of these companies so my review is purely my own unbiased opinion.

Julian’s Paleo Bread- Almond I found this treat at Whole Foods and despite it’s price (nearly $10 for a loaf) I decided to give it a try to hopefully satisfy some of my “carb” cravings. I honestly wasn’t sure about it at first but now I have grown to enjoy it. While I still believe that you could make a tastier version at home yourself, you’re buying it for convenience and the fact that it can stay frozen until you need it. It does contain egg so make sure you look at the ingredients before you buy if you have certain intolerances. It tastes like a very dense version of a piece of whole wheat bread and the fact that I could make myself a grilled cheese (yes I’m eating cheese right now) means I’m sold.

Tessemae’s Salad Dressing In a perfect world you would always make your own salad dressings from scratch and they would be flawless. But when that doesn’t pan out, Tessemae’s dressings are an excellent option. Using only a few simple ingredients and producing a variety of flavors, Tessemae’s provides some great products for a reasonable price. I pretty much keep a bottle in the fridge at all times now. You can find it at health food stores (I got mine at Whole Foods) or order online.

Wild Friends Organic Sunflower Butter All nut butters are not created equal and you will especially love this find if you are nut intolerant but still want the consistency and taste of a jar of nut butter. Not only is it organic and sweetened with organic honey, it’s delicious. Not joking, I could eat it all day. AND I found a large jar at Costco for less than $10. The Wild Friends company also makes peanut and almond butters (including vanilla espresso almond butter!) but still check the ingredients since some are sweetened with other ingredients besides honey. You won’t regret buying a jar of this treat.

I will keep you updated as we try new products and develop a cooking schedule. Keep an eye on my Instagram account for exactly what we’re eating and cooking.


And last but not least I hope you’ve enjoyed some of these absolutely gorgeous maternity photos that my friend Amy Vaughn of Garnet Lane Photography did for us! Besides the fact that she’s a dear friend, she has an incredible mission and ministry with her photography to help children in Africa. If you’re in the DFW area, I would highly recommend checking her out!

Seth and I are both overwhelmed with the fact that there’s a growing six-pound baby (with hair already!) that we will get to meet very soon. When I think about how he or she has developed with all it’s intricacies, with each bone and muscle in place, I can’t comprehend the miracle of it all. Changes have come and we expect many more but we are beyond excited to move into this next phase of life, knowing full well that sleepless nights and tearful moments won’t even compare to the joy of interacting with our little human. There are fears and uncertainties at times but the awe of carrying this little person outweighs any trepidation I have and I’m confident that God will sustain us no matter what the future holds and will continue to give us joy we can’t even imagine yet.

Hopefully I’ll have time to do a post or two more before baby comes but if not, follow me on FB or IG to see what we’re up to! Wish us luck!


The Conversation about Death and Dying: Part One


No one wants to talk about death and dying.

I’ve sat down to write these posts many times and I’ve struggled with each attempt. Not because I don’t have clear ideas and opinions and thoughts I want to convey, but because the topics of death and dying are extremely arduous and laden with expectations, religious beliefs and emotions. It’s a highly individual topic meaning every person carries around their own experiences or values that inform their views. I hope you can take my words as simply my opinions and observations, not my recommendations for the right or wrong way to combat these heavy issues. I hope that you can understand my perspective and that you can reason through your own views in a productive way.

There are reasons we avoid talking about death. Death is sticky and weighty and complicated. It’s heartbreaking and emotional and sometimes tragic. It uncovers aspects of ourselves that we preferred to keep hidden or at least submerged amidst the routines of daily activities. It causes us to stand face-to-face with our worst fears. It weaves itself insidiously through every aspect of our lives, whether we are conscious of its presence or not, like a whisper that we most often choose to ignore. It wreaks havoc at the most inopportune moments and causes widespread devastation that no one, regardless of the preparation, is ready to handle. But it’s also mysterious and sometimes relieving in an odd way that’s difficult to describe. It’s not always a negative experience despite the generic connotation, and that fact alone proves it to be a topic worth exploring. Death has many facets, positive and negative and everything in between, and we will delve into a few of them in this discussion over the next few posts.

After working as a RN in the ICU for over six years, unfortunately I’ve been witness to and a participant in many hospital deaths. In my specific job in the trauma ICU I spend the majority of my time with patient’s families. I’ve attended countless family meetings and listened to physicians convey horrific news, sometimes stumbling over their words painstakingly and other times communicating the heartbreak in such a meaningful and sensitive way that we are all left in tears. I’ve worked with wonderful hospital chaplains as they comfort those journeying through the loss and offered my own shoulder as an instrument of grief. I’ve had to say the words, “I don’t know” and “I’m so sorry for your loss” more times than I can remember. Several of those patients and families I know I will never forget.

At the bedside, I’ve watched person after person pass away, sometimes in a frenzy of chaotic intervention like chest compressions and shocks or other times in a dignified, peaceful manner with family surrounding them for those final moments. I’ve also sat with dying patients in empty rooms, holding their hand while they take those last few breaths, not wanting them to have to do it alone. Sometimes I cry too in these moments, and sometimes I simply feel a genuine awe at the cycle of life and death that isn’t accompanied by tears. I’ve had some personal experience with hospital death as I sat at the bedside of my own dying family member putting together all the pieces of experience I’ve gained to help my own family through the process.

Unfortunately, I would consider myself well versed in the aspects of death and dying and while many times that is painful, those experiences are the ones that have changed and molded me as a nurse. I don’t consider myself an expert and I don’t have any additional qualifications that make my opinion more reliable or authoritative than others. But I feel that these issues must be discussed and dealt with for all of us to grow in both our professional and personal lives.

Part One: Family Meetings for End-of-life Discussions

This post focuses on the topic of family meetings as the avenue for discussions regarding end-of-life care and begins to explore the motivations and goals behind them. This post is an introduction of sorts to the deeper issues that we will be discussing with goals of decision-making in Part Two.

While there are numerous complicated issues that need to be discussed between providers and families, I’m going to hone in specifically on the topic of imminent death and discussions surrounding palliative care versus long-term life-sustaining measures to limit my own verbose opinions. Personally, I care about the issue of pre-emergent decision-making so profoundly that I joke about leaving the bedside to do community education on DNRs, Living Wills, and Medical Power of Attorneys. These are all invaluable legal documents that prove immensely useful in end-of-life situations. In the ICU specifically, heartbreaking decisions have to be made on a daily basis and over time we (the broad medical community) have developed an effective way to get information to families and help them make wise decisions.

I’m not writing this to explain how to conduct a family meeting because you could read a plethora of evidence-based articles that provide more accurate and thorough information. I’m also not insisting that my institution’s way is the only or best way to convey information to families. Instead, I’m going to present my observations from a bedside nurse perspective, interject my hopes as we all progress towards more effective communication, and ask some thought-provoking questions.

If you aren’t familiar with the concept of family/medical conferences, I will give you a brief overview. Family meetings can be held routinely to update family on the patient’s plan of care and also can be called specifically when tough decisions need to be made like end-of-life decisions or long-term planning. Sometimes these meetings take the form of a more formal sit-down in a conference room while others are forced to be more impromptu at the bedside if the patient’s condition is deteriorating quickly. Regardless of how it looks, the end result is that the family (and the patient if they are able to participate) is informed and comfortable with the current plan and that they have all the information they need to make those big decisions.

Here’s my first observation regarding end-of-life discussions: a prepared and trained physician/practitioner is worth their weight in gold. When the provider has had palliative care experience, has been well coached in the process of navigating such tenuous topics, or has had extensive experience in these types of discussions, everyone benefits. The practitioner is honest and uses everyday language, not sugar-coating the morose information but conveying it in a caring and gentle way that helps the family know we are all here to help. The family is given time to process and repeat the information and a productive exchange can occur. In a perfect world, every conversation would end in some form of agreement or at least mutual understanding but that’s not always the case for several reasons.

If the provider isn’t prepared or confident, it’s usually not because he or she is incompetent but rather because he or she hasn’t been given adequate tools for such a weighty task. Providers should receive some sort of training regarding these discussions, although in my experience that training is usually colloquial and very dependent on their senior staff, hospital culture, and perceived importance. Provider personality also plays into the mood of the discussion. Some practitioners are simply easier to converse with and have innate people skills that others may lack. Depending on their primary specialty, some providers feel more comfortable based on previous experiences (the brand new pediatric intern should probably not take the lead on a difficult family discussion regarding end-of-life for an elderly cancer patient). When a provider does feel inadequate for the task or wants additional support, the palliative care team is often present to help, although many smaller or more rural facilities don’t have a dedicated palliative care team.

For countless reasons, every staff person to be involved in the discussion should ideally “huddle” before entering the conference to ensure consistency of goals and information. This simple task is evidence-based and I believe is vital in preventing discord or errors and helping the entire process to function smoothly. I’ve had physicians ask me really good questions prior to meetings and the exchange of information helped to facilitate a smoother discussion.

As a nurse, you play a crucial role in these meetings. Many times you can help “bridge the gap” between provider and family and ensure that the family understands exactly what the provider is trying to communicate. While I usually don’t intervene much, I have stopped the provider during a meeting before to clarify information if I feel that the family is confused or to re-direct the conversation if it’s getting too heated or going in an unhelpful direction. Don’t hear me say that I know better or can supersede a provider. I’ve simply had enough experience to know how to benefit the group as a whole as we have this collaborative conversation. If everyone views meetings as a group effort with each person playing their part, discussions regarding end-of-life care can be very productive and helpful. Most practitioners are wonderful and families walk away feeling content at least with the communication of information, if not the subject of death and dying.

And by no means does every family encounter ensue in this calm, collected way. Many times it’s a quick bedside conversation with the family before we start to code a patient or in the hallway as we wheel the patient off to CT scan. It’s not always calculated but that’s the nature of medicine and humanity frankly: it’s unpredictable and we have to adapt to the situation in front of us. We do our best.

Here’s my second observation: despite even the most eloquent and meaningful conversation, you can’t control a patient or family’s reaction. Many times families respond with an array of emotions that can complicate the conversation including anger and denial, or they express a sheer inability to cope.

While the goal is for everyone to feel comfortable with the information, those initial reactions of family members are normal. Often they are fearful or in extreme grief and that grief manifests itself as anger or denial or sometimes even rage. No one can say what a person should or shouldn’t be thinking as they navigate through their own feelings. You can’t blame the elderly husband for refusing that his wife is dying of cancer. You can’t convince the mother of the teenager boy that he will never walk again. It takes time to process through those emotions and as nurses, we can prove instrumental in helping them cope with their grief by listening, offering support, and putting them in contact with others who can provide more sustained and in-depth help. The provider can only be held responsible for their own words in the conversation, not the outcomes because those vary widely depending on the issue and the specific patient.

I consider it an honor and a privilege to be a part of such meetings and I have a huge amount of respect for the physicians and practitioners who have these discussions daily. While we have established a good routine, there’s always room for improvement and hopefully in the future we will see more advanced training for nurses, providers, and other staff members regarding end-of-life care that will lead to better hospital outcomes and patient and family satisfaction.

Here’s the deeper question that we will be delving into in Part Two (the next post) of this discussion: Why do we care so adamantly about making these discussions informative, productive and meaningful? What is the goal?

How does your hospital or facility conduct family meetings? What suggestions do you have to make them run more smoothly?

Here’s a great video on how to conduct a family meeting from Dr. Diane E. Meier who is Director of the Center to Advance Palliative Care (CAPC)


Becoming a Working Nurse Mom

This is a post about motherhood, or maybe about being a working mom, or maybe about changing my nursing career to fit the needs of my family and me. Maybe it’s a post about everything, about how lots of things in life get intertwined in strange and complicated ways and you’re left with a beautiful tangled mess. Whatever this post is or isn’t, it’s my attempt at explaining how I came to a very important decision but also about all the decisions that are yet to be determined.


I always assumed that by the time I had a baby, I would have my life “figured out”. My career dreams would have been achieved or at least defined, my desires solidified into quantifiable, attainable goals, and I would be content in my life experiences. I would be set in my career, my dreams would spin to be centered on my family and I would happily retire to stay-at-home-motherhood for the season while I had young children. These assumptions are not bad, in fact, I think they are of the most honorable sort.

I always thought of the days of babies as a future event, one that never got too close to me, even when we started having theoretical conversations about theoretical children.  I think I got the previous assumptions and inclinations from a million different sources like my own family, society and the culture at my work. But I believed a lie in the midst of those assumptions: the lie that once we get to a certain stage, we will be that glorious future version of ourselves who has it all worked out perfectly.

Instead, as I sit here marveling at this kicking child, I find myself more upended than ever about who I should be, what I should do, and how I should do it. After all those visions of my future composed self, ironically I’m still the same sporadic self, one who is having to sift through all my new roles and come to a new definition of who I am and what I want. All I know for certain is that I want to take care of my husband and this child, and that I’m not ready to give up working entirely. I feel called to do both.

Now before I get into the gigantic question of whether mothers should or shouldn’t work outside the home, hear me clearly when I say that I believe that decision is unique to each individual. Out of all the debates that I’ve heard during this pregnancy, this one is the most fiercely argued and defended (except possibly the epidural question), sometimes provoking advice that I didn’t ask for or want. After talking with other moms, reading books and articles, reading the Bible and thinking long and hard, I’ve determined that the dilemma of “to work or not to work” outside the home doesn’t have a straight answer and if you’ve had to determine this for yourself, you know exactly what I’m talking about.

Besides desire or conviction, mothers often have to take into consideration a million other factors like finances, childcare, health of yourself and/or baby, and time. I don’t think any mother takes it lightly and certainly no one deserves condemnation regardless of whether or not their choice lines up with your personal conviction. In the end, you follow the path that you believe will benefit your family the most. You make hard choices, whether that hard choice is to give up work or to stay, and trust that you’re doing your best with the information you have.

In my case, I couldn’t rest on either side of the debate. On one hand, I always thought I would want to be a stay-at-home mom and honestly surprised myself that I wanted to continue working to some extent, to continue to build my career as a nurse. For as much drama as I deal with, I love my job working with families in the ICU. It’s opened up whole new dimensions of the realms of customer service, ethics, end-of-life decisions and coping mechanisms. I understand how to deal with people in different ways, how to communicate difficult issues, and how to process through my own emotions in a productive way. My job has stretched me and taught me and I’m sad to let it go. I’ve mourned the loss to a certain degree.

On the other hand, I’ve worked full time in the ICU for six years now and it seems like this is a good time for a break. Very soon I will be leaving my full time position working with families in the ICU and will be working part time solely as a staff/charge nurse again. Thankfully, my job provides flexibility that many others don’t and we have family members who have graciously and eagerly offered to keep this child on days when my husband and I are gone. Thankfully, financially we had the room to consider a part-time schedule and my husband is overwhelmingly supportive for either route. Thankfully, nursing has opened many doors that women in the corporate world or other professions don’t have as options.

Believe me that I did not take this decision lightly, in fact I probably worried about it more than I considered it, even before I got pregnant. I ruminated over whether this child would be damaged by my absence for hours during the week, whether I would regret missing those fleeting moments, and whether this change seemed like a good fit for our family at the time. In the end, I had to pray and trust that after seeking the wise counsel of others and having endless conversations with Seth, that I had to move forward with my conviction to have a little bit of both- some time at work and the majority of my time with baby.

But my angst over life decisions doesn’t stop at the working controversy. Honestly, I wish it did. Sometimes I wish that I didn’t have so many other desires that tug on my heart like cooking, writing, and even going back to school to become a nurse practitioner. Fortunately, those dreams don’t hold an expiration date based on age, like becoming a football player or a ballerina. Those particular goals quickly dwindle if you get past your teen years without any solid evidence of your athletic genius. But dreams like writing a book never expire. And each time I sit down to write my thoughts, I only improve my skills and vocabulary. Every book I read gets me one step closer to understanding how to put words and phrases together. Every recipe I make gives me more expertise into how to turn ingredients into food. Every shift I work as a nurse gets me more experience that will go towards an advanced degree one day. Unknowingly, I’m working towards those deep desires of mine on a daily basis as I go about my routines.

One of my coworkers, with several decades of wisdom more than me, made a passing comment to me that I haven’t been able to forget. She said no one figures out their life until their thirties. She wasn’t trying to insult me by saying this (I’m 27), she meant it as an encouragement. Hearing this provided an overwhelming wave of relief but I also think her statement applies on an even broader level that’s not constrained by years. I think you never really have it all figured out, although you would like people to think you do. Maybe some lucky individuals feel completely oriented all the time, but I would venture to say that most experience seasons of wavering desires and undulating goals. But her nugget of truth proved extremely thought-provoking and has given me the freedom to feel like I can still try and fail and change directions.

So I’m taking a shaky step away from what I know and moving towards new adventures, some consisting of diapers and baby snuggles and some yet to be fleshed out. Nursing is an excellent career with versatility and flexibility not available in many other jobs and I know no matter what other interests I take on, I’ll always be a nurse. It’s a part of who I am; it’s how I see the world. And now I get to take my profession into a new phase of life and see what exciting prospects emerge with a stethoscope in one hand and a baby in the other.

All I Want For Christmas


While most folks will be spending the next few days enjoying their families, indulging in holiday foods, and relishing in a few days away from the office, many healthcare professionals will be hard at work at the one place that doesn’t ever close: the hospital. Some nurses are fortunate enough to have positions that don’t have holiday shift requirements and some nurses actually quite enjoy the festivity of hospital holidays and spending time with the patients who can’t go home for the sake of their healing and recovery. Some nurses don’t celebrate the same holidays because of cultural or religious reasons and they happily volunteer to take those shifts for those of us who want to participate and we all appreciate their selflessness.

I have spent my fair share of holidays at work continually snacking on the enormous feast in the break room and sharing Christmas cheer with my patients and families. Some holidays are quiet and uneventful while others are full of drunken accidents, family disputes resulting in a stabbing incident, and the occasional kitchen burn disaster in a dramatic attempt to cook Christmas dinner. Whether you’re working over the next few days or not, thank you for committing to the well-being of your patients, especially if you’ll be away from your own families. Here are few funny requests on the nurses’ Christmas wish list. Feel free to add your own in the comments below!

All I Want For Christmas is an affable on-call physician who is full of nurse-friendly Christmas cheer as well as a good amount of experience and expertise.

All I Want For Christmas is one single admission who doesn’t come in drunk or high. Just one person.

All I Want For Christmas is a functional arterial line that can successfully draw all my millions of labs the infectious disease doctor just ordered. Oh yeah, and some good veins for all these fresh stick blood cultures.

All I Want For Christmas is propofol.

All I Want For Christmas is for no one to pull out any tubes or lines or self-extubate. Did I mention all I wanted was propofol?

All I Want For Christmas is to not have to go to GI lab or IR or STAT CT. Just leave me in heavenly peace at my bedside.

All I Want For Christmas is a lame admission with a nice family who doesn’t complain about the lack of comfy chairs, doesn’t write down every word of out my mouth, and brings us candy.

All I Want For Christmas is to leave the crash cart in its designated spot, intact and free from interaction. Or, if it’s an especially boring day, all I want is to use the crash cart.

All I Want For Christmas is for my favorite coworkers to be on with me and for someone’s spouse to bring us Starbucks.

All I Want For Christmas is for as many patients as possible to be discharged so they can spend the holiday with their family.

All I Want For Christmas is for no one to come with a massive head bleed or from a devastating car wreck. All I Want is to not have to cry at the bedside with some weeping spouse or mourning child. All I Want For Christmas is to not have to do death paperwork.

All I Want For Christmas is the nice eighty year old patient who continually thanks you and tells their own family to be quiet out of respect for the other patients.

All I Want For Christmas is for the hospital staff to come around singing off-tune but heartfelt Christmas carols.

All I Want For Christmas is to be working at the children’s hospital where Santa comes around giving out presents, rather than me handing out enemas.

All I Want For Christmas is to come home safely that night to my own family, extremely thankful for my health and that I could make the holidays just a little bit brighter for the patients who didn’t have the option of going home.

Merry Christmas and Happy Holidays everyone!

I Know How You Feel


Not very many people can truly say to an ICU patient, “I know how you feel.” Even when they do, most patients roll their eyes annoyingly thinking, how could you possibly know what this feels like. And for the most part, they are right. People often, in good intention, try to develop that sense of communal suffering to show compassion and empathy, as if your high-speed MVC with an ex-lap, multiple rib fractures, and head injury is synonymous with their tonsillectomy. The well-meaning visitors don’t intend to be insensitive or trivial, but you can’t compare most medical situations and there’s really no point. Often people just want your presence and support and an acknowledgement that yes, this situation is terrible and I’m sorry.

Nurses have learned not to utter the phrase to patients, “I know how you feel,” because we realize that we vastly have no understanding of the pain you feel with every breath or the shock of waking up with a permanent colostomy or the difficulty of remembering your name through your hazy head trauma. We recognize our inability to relate and mostly give thanks that we’ve not found ourselves in the patient’s position.

Families present a different situation. Many of us have in fact watched a family member pass away at the hospital or had a relative who was an organ donor or an aging parent with a debilitating illness. In those situations, it’s easier to utter that phrase because we have a better idea of the range of emotions and hardships that run concurrent with such challenges. Often, families are appreciative and take comfort in knowing that they’re not the only ones having to endure such suffering.

But sometimes you find yourself in a desperately unique situation, one that after time comes full circle and makes you realize that life is both ironic and intentional.  It becomes one of those moments that you look back on and see that it shaped you, made you the person you are today, and despite sadness or pain, it turned out perfectly with some perspective. Did you know that I have such a secret? It’s one that probably the vast majority of you don’t know because I’ve never told it on the blog. It’s a tale that’s not too rare but also not extremely common. A story that means I truly can say to my patients, “I know how you feel.”

As I sat in the big hospital auditorium months before my college graduation, resume in hand, watching the other applicants rise to the front as their names were called, I thought about the irony of my situation, the irony of me applying to work in the trauma ICU. The fact I had been there before, as a patient, nearly eight years prior to my hire date.

One minor decision lead to one miscalculated turn, one uncontrollable gravel slide and then one major accident. My dad pulled me out from between the parked car and the go-cart as I gasped desperately for breath. It was a strange feeling: hyperaware yet in a daze. I even thought to myself, “what if I die from this?” I had never seriously considered that question before in my fourteen years of life. A ninth-grader with little awareness of my mortality.

I remember few scattered memories during my care flight transport to the hospital and admission including feeling self-conscious as they cut my clothes off in the trauma bay. I recall the cute male flight nurse, wondering to myself, does my hair look crazy? I remember he feeling of wanting to wake up but being unable to; fighting against my own battered lungs for air.

I don’t recall the sticks and blood draws or invasive lines. I can’t remember any doctor or nurses name. And thanks to modern sedation and pain medication, that’s perfectly acceptable. I didn’t understand the severity of my accident or the whispered conversations being held by nervous physicians. I was ignorant of the entirety of my trauma, sleeping away in my sedated state.

After a fairly severe accident, I had come out with a punctured and partially collapsed lung, several broken ribs and a liver so damaged the doctor told my parents it looked like someone dropped a watermelon on the ground, letting it shatter to pieces. Thankfully, your liver is the only organ in your body that regenerates and literally re-grows itself so I at least had that advantage. I was also young and athletic, my body poised and ready for a rapid recovery.

Everyone monitored my blood levels meticulously as they dropped, point by point, down to a critical low…then began to rise back up. My body triumphantly won, allowing me to avoid surgery and a huge resulting abdominal incision. It was a gamble on the doctor’s part and I’m so glad they bet on me. Again, I didn’t understand the medical language or the purpose of the daily procedures. But when I managed to open my heavy eyelids from time to time, I noticed the fear and worry stencilied across my parent’s faces. They were desperate for any positive sign, any sign that I would make it out of this predicament unscathed and alive.

Ironically, stronger than any of the pain or discomfort or emotional heartache was my desperation for water. I was insaitably, irrationally thirsty with strict instructions not to take one sip until the team was convinced I wouldn’t require surgery. Even with continuous intravenous fluids keeping me hydrated, I craved the wet taste on my tongue, the relief of that clear liquid.

Water: it’s something you completely take for granted, until you’re banned from it.

A few ice chips may have slipped by here and there at the hands of my compassionate mother but it’s comic to me that out of that entire experience, my most vivid memory is craving the world’s most standard resource.

Cards and flowers showed up with neighbors and friends. The principal, the pastor, the complete entourage of those dedicated to visiting the sick. Ignorant of the severity of my condition, I didn’t quite understand everyone’s enthusiasm for my well-being as I graduated out of intensive care.

I remember my kind nurse on the floor who stroked my hair and spoke gently to me. I remember feeling self-conscious about the thin gown covering me as my friends from school came to visit. I remember one of my friends trying to hang Christmas lights in my room along with a bursting collection of student-made posters, only to be informed it was all a fire hazard.

I eventually stumbled home, reasserting myself on the couch for another couple weeks as my teachers excused me from my assignments. As muscle spasms settled into my shocked body, I gasped for air through the pain, forcing myself to take slow shallow breaths until the cramps subsided. But day by day I improved and grew stronger. I remember those incremental instances of my improvement well.

Walking to the mailbox, a victory!

Going to see a movie, incredible!

Journeying back to school, looking like an emaciated ghost, a bag of pale bones. Deciding to attend the school dance in an impromptu fashion, despite my convalescence.

As you can imagine, the experience wasn’t quite so innocuous for my parents. They gripped my tiny hand every hour of the day at the bedside. They prayed and cried and let themselves rest on the shoulders of others. They hoped and, thanks to the miraculous nature of the self-healing human body, watched me improve back to a shadow my initially healthy state.

I cant imagine the horror they went through, but I understand it much more now as I watch families of young patients suffer in the ICU. My parents sat where they sat and someone cried with them and tried to reassure them. Probably a nurse like me, now. The tears of a parent can be the most bitter and desperate, but also the most hopeful.

Now comes the even more strange part. About a year after my recovery I had a dream, a strange, oddly clear dream. I saw myself lying in my bed on the hospital floor ward, the same bed I had inhabited during my time there. But I also saw myself standing over in scrubs as the nurse. I played both roles, the patient and the nurse, mirror images. And from then on, I knew my future profession. I didn’t question it or give it much more thought; I just knew I would take on the responsibility and privilege of nursing. God used that trial to show me who I would become.

Years later, when I interviewed for the position, I suddenly realized my extreme advantage, the fact that I could truly say to the patients lying in those ICU beds, “I know how you feel.”

Now I can say those words with honest compassion and empathy, although there are still aspects of the ICU that I didn’t experience. The words aren’t just a cliché uttered by a well-intentioned staff member. I know how uncomfortable it is to get a tube shoved down your nose into your stomach. I have experienced the sting of IV needles and ABG draws. I distinctly remember the embarrassment of a bed bath. Our attending physician, who was only a resident when he took care of me, and I now laugh about how I cried when he told me I couldn’t be a part of cheerleading for a while.They are true words from my mouth proclaiming hope in the midst of a tumultuous place, a light in another’s darkness. Not everyone has such a story and while it was painful, I don’t regret it and I’m glad I’m able to relate my patients in that way, although I don’t share that story with them very often for one reason or another.

I hope for your sake that you can’t say, “I know how you feel,” but don’t think that your presence is any less valuable or your words any less meaningful. Be assured that your actions at the bedside everyday are enough, more than enough as you pour out yourself for your patients and families. They notice your kind words and your expertise and appreciate it more than you can imagine. Believe me, I know. I felt the very same way.


How To: Handle Emergencies


Natalie-8There are certain days that stick in your mind permanently, days full of crash carts or emergency intubations or the unexpected stroke. Sometimes no one saw it coming or maybe you work in intensive care and were waiting nervously for the patient to crash with a syringe of epinephrine in hand. Whether you’re fresh out of nursing school or a seasoned RN, you’ll probably never forget a defining moment of your career: your first code, or a similar experience of critical importance. Your hands were shaking, pulse pounding, and it took you several days to process through all the emotions surrounding such a traumatic and exciting experience. I know I’ll never forget my first code, which I relayed in this post.

Handling emergencies of any type takes practice in both physical and mental skills. You review a checklist of actions and run through scenarios in your mind. You probably practice chest compressions in a lab with an instructor or observe the rapid response team as they move frantically around your patient. Having a steady hand when your critical moment comes requires time, effort, and thought, and developing those instinctive reactions doesn’t happen overnight. Many times you won’t even realize you’ve acquired those skills until you’re in the moment. Suddenly you know what to do, where to move, and when to call the physician. Without anyone telling you to, you titrate, do chest compressions or support an emergency response team at your facility. But how do you get to the point of instinctive reactions? When do you “cross that line” from novice to experienced in these matters and what steps can you take to be prepared? If you have little exposure to emergency situations in your area, is it really that important to be proficient in those skills?

Regardless of your clinical area or the degree to which you encounter emergency situations, in my opinion it’s extremely important to know how to react, because one day you might be at the mall or a baseball game when someone arrests or your child might choke at home. Emergencies are not limited to the hospital and as nurses, I believe it’s our responsibility to maintain our knowledge base for such a crisis. Many of you do this through professional certifications like BLS or ACLS but we all know performing CPR on a mannequin in a lab is vastly different from the bedside. Plus we’ve all heard them call a code blue from a clinic or the lobby of the hospital so you never know when V-Fib might attack. And you just hope and pray that they don’t (or secretly wish that they would) call for a nurse on a long airplane flight and suddenly you’re on stage, needed and necessary, armed with only a basic first-aid kit and your nurse brain.

Honestly it was several years in intensive care before I felt like I could instinctively respond in a code situation. As a new nurse, I watched others and marveled at their ability to infuse and flush and yell all at the same time in a flawless motion. They were all so smart, so seamless, and I felt like a fish out of water. I wondered if I would ever gain real confidence and it wasn’t until I became an ICU charge nurse that I felt like I got real, frequent exposure to those types of situations. After doing my charge training we had five codes on back-to-back days and while I wanted to run and hide in the bathroom, I was forced to step up, take control of the situation, and utilize all those skills I had been developing for years.

Here are a few tips I’ve picked up along the way, mostly from mistakes I’ve made or things I wish someone would’ve told me. And while we all have moments where we feel overwhelmed, I’m confident that with some practice and preparation you can feel ready to take on those emergency situations.

Know your resources. By this statement, I’m saying know who you can rely on for help when such a crisis arrives. We all can easily pick out those more experienced nurses who are skilled in responding critically. Even if you don’t know what to do, grab someone who does and learn from them. Sometimes those nurses may not follow an exact routine because they are able to put many pieces of information together at once and assess needs simultaneously. Sometimes they will simply remind you to put the defibrillator pads on your patient’s chest as you stand there in shock and awe. You’ll learn more than you realize by observing and copying the actions of those seasoned nurses around you. Don’t be afraid to ask for direction if you get stunned and find your feet glued to the floor. Running a code or responding to an emergency situation is a team effort and more than likely you always have a charge nurse or manager who can help you out.

Try not to panic. This one is easier said than done, especially if you don’t encounter many critical situations. As we know, there’s a level of good stress that stimulates adrenaline and helps us to move effortlessly and quickly. But that same adrenaline can paralyze you and hinder you physically, mentally or emotionally from being able to fulfill your role. Recognize that a code blue is a life-and-death situation and that you need to move quickly but don’t let that overwhelm you to the point that you shut down.

Practice the what-if’s. I used to do this very often as a new nurse and I still do sometimes for fun (fun?). I think to myself, “ok, what if this man stopped breathing?” or “what if he suddenly went bradycardic?” Then I would process through my reactions, making sure I was attending to the most important needs first like an airway or emergency medications and then running through secondary needs like an OG tube or chest X-ray. I would also review what medications I would give in what dosages because that can get confusing, especially if you have to calculate based on weight. You can also perform this mental exercise at a public function like a college football game by paying attention if you see an AED or an emergency tent. It might sound over analytical and downright nerdy but if that moment ever comes, you’ll be prepared and I’m pretty positive some unlucky person will thank you for it.

Know your equipment. I’m still surprised at all of the goodies that lay buried in the depths of the crash cart so if you get an opportunity, familiarize yourself with the location and variety of the contents. I always advise new nurses to dig through a crash cart after a code situation is over to see what is where and how they could use it. Also, don’t ever leave your unit to travel without your emergency equipment! When your vent stops working in the elevator and your patient bradys into the 30’s, you’ll be glad you have it (yes that happened to me). You don’t want the one time you forget a piece of critical gear to be the one time you need it.

Remember to process. After the rush and adrenaline of an emergency is over, you can be feeling a million different emotions. You might feel relief, pride, or loss depending on the patient outcome. You might feel frustrated or overwhelmed or even excited. Any reaction you have is valid so take some time to process through what you feel and why. It might take some time but by reviewing not only the scenario but also your own personal experience, you will be better prepared for future crises. If you find yourself particularly upset or stuck on a certain event, reach out for someone who understands, whether that’s a coworker, a family member or someone designated by your facility to help you cope.

I could give you many more tips but your instincts will mostly come with time and countless emergency intubations. Give yourself grace if you don’t have much experience with emergencies, recognizing that each time you will be able to react faster and more proficiently. All you can do is be prepared and do your best when that situation arises, even if you’re stuck on an airplane.

Pregnancy Initiation: the ICU Nurse’s Experience


DSC_1340Since I work at a very large urban hospital here in Dallas, people often ask me if I know a friend or relative who is also employed there, like there is some kind of hospital-wide nurse coffee date program where I mingle with nurses from all floors and disciplines. I usually barely even consider the name, not out of insensitivity, but because most likely out of the thousands of people who work there I don’t know this person. If they work in trauma, it’s likely. If they work in surgery, it’s possible. But then someone asks me about a labor and delivery nurse and I jokingly reply, “oh no, they are from a completely different side of the world.”

In hospital terms, my trauma intensive care unit is as distant from the world of babies and breastfeeding as it could possibly be. We don’t see the same kinds of patients, we don’t have any nursing common interest except basic human pathophysiology (which we share even with the psych people) and we are in totally different towers of the hospital. And on those rare occasions when I do encounter someone from those mystical few upper floors, it is for some catastrophic patient who required a total hysterectomy and massive blood transfusions and resuscitation. Needless to say, we aren’t introducing ourselves and exchanging credentials in this scenario. In a few words, no, I do not know your friend, although thank you for asking.

But even though I have never stepped foot onto those floors, never cared for a laboring patient, and honestly still feel somewhat awkward holding my friend’s children, I have now found myself smack in the middle of the baby world by experience. Since the moment that plastic stick said “pregnant,” I’ve been suddenly inundated with the world of pregnancy and childbirth and found myself completely overwhelmed.

On one hand, I was completely (and unknowingly) ignorant. Whenever you tell someone you’re pregnant, whether that’s your physician or your mom or the check-out person at Trader Joe’s, everyone has a piece of invaluable advice, the diamond-in-the-rough of pregnancy that you cannot live without. Heed my words carefully and memorize them because this one thing will save you. This specific swing or this book or this food to avoid indigestion. It’s like the underground railroad of communication, like no one has figured it out the way they have and you’ll be desperately lost if you don’t register for these five life-saving products.

So I eat all this advice up, jotting down notes in my phone for a book to read, a blog to peruse or a tip to remember. And it quickly becomes a vast mountain of electronically stored information that seems random and disjointed because at ten weeks, I had not investigated my parenting strategies yet. And more than that, how much was I expected to know about the world of pregnancy before I got pregnant, especially being a nurse? What exactly are the expectations of my knowledge at different stages of my pregnancy? What should already be routine to me as a nurse, even though I have not seen a baby being delivered since nursing school? What the heck is the difference in all these strollers that look identical to me?? If you could see inside my mind, it’s somewhat of a comedy of errors that cycles back and forth between complete confusion and rabid internet consumer investigation. Because I am not going to gamble my crib mattress decision on the fifteen year-old Target employee’s advice.

On the other hand, I did have some experience working in labor and delivery as a nursing student: a whole month of shifts during my last semester of nursing school in fact, and that provided me with a deceiving amount of pride (that was immediately squashed by the influx of baby-related questions). In school I had seen a C-section, a vaginal delivery and even a STAT c-section. What more could there be to it? How hard could it be when women do it everyday across the world in a grass hut with nothing but a dirty towel and absolutely no hand sanitizer. What essential keys could I possibly be missing for an activity that is as vintage as Adam and Eve? HOW HARD COULD IT BE?

So I slacked on voracious reading in my first trimester, mostly due to the fact that I was physically asleep the majority of the twenty-four daily hours, and trusted that my innate nursing compass would lead me in the right direction towards the scenario where I have an effortless labor, a healthy baby, and butterflies floating around my perfectly sweat-less head. The OB would ask me what questions I had and I would simply shrug, not yet worried about making a decision about cord blood banking or epidurals. I simply wanted to know if we could still travel to Italy at the end of my first trimester and was it normal for me to cry because someone honked at me at a stoplight.

But as soon as I recovered from the foreign and uncomfortable world of nausea (those six letters cannot begin to contain the range of experiences listed under that title), I realized the epic and infinite amount of information at my fingertips and how much knowledge I lacked, even as a nurse. Just because everyone puts in an IV the same way did not mean that I knew what to expect for labor or how to care for an infant. Simply because I had seen a handful of labor experiences did not indicate that I knew a single thing about how the process will go depending on whatever situation I end up in for my delivery. I bow to you L&D nurse and repent of my pride. I admit there is more to it than verbal encouragement and listening to fetal heart tones.

Since then, I’ve started stalking my friends who have recently had kids and those who I distantly know are labor and delivery nurses. I want some kind of reassurance that I won’t be completely inept as a mother and I won’t freak out during labor causing them all to look at me like the crazy ICU nurse who knows just enough to be too much. Looks like there’s a lot more to it than pushing and cutting and swaddling.

Thankfully, I’m not alone. Every first time mother has told me of similar reactions and panic attacks and their children are alive and healthy. And I’m still banking on my internal, female mama-bear instincts to help me out when the time comes. Despite my initial pride, I’ve been humbled to a new level of ignorance that cannot be founded upon my nurse abilities to participate in a code without an ounce of anxiety or do six beside procedures in one shift. Yes, we’re going to go to the childbirth preparation class that I initially thought would be absolutely superfluous. Yes, I’ve started reading and asking my doctor in-depth questions about birthing scenarios. And yes, I’ve gained a whole new level of respect for those nurses who navigate the intricacies of the “baby side of the world” and I’m sure that will only vastly increase when I actually go through the whole labor experience. Looks like I’ll be a writing a “Part Two” to this post in four months.

In the end, I will be changed. I will be completely and utterly transformed because of this tiny human who will enter the world with my tears of joy and an entire waiting room busting with family members. I will be a better friend because I can relate to people in another gigantic and universal way. I will be a better daughter, daughter-in-law, granddaughter, sister, and wife because I can now step into another set of life shoes. And I will be a better nurse because not only will I have gained a valuable perspective of an area I had previously essentially ignored, but I will also have a deeper respect for those nurses who (literally) keep the patients alive and coming.

In the meantime, feel free to contribute your diamond-in-the-rough piece of advice and I promise to faithfully google until I have a sufficient answer. Third trimester here we come…