mom of boys

Single mom life with twin boys: Overnight Illness

Most parents I know are over this Winter and it’s many illnesses. I am one of them. We’ve had the flu- actual flu- and a couple bouts of stomach bugs. It never runs concurrently. Always consecutively. So as the single parent with one after the other illnesses…unfun.

I realized I reached my max when I woke up to a chunk of my bathroom cut out. I thought, “What the hell happened?” then the fuzzy memory of 1 AM entered my hazy and tired and brain.

We had been on play dates on Friday. We got home late and my sons are extra dramatic on Fridays because it’s the end of the week and they are tired. I was feeling pretty pumped about the playdates because one of them I actually got to drop the boys off and leave! It’s a family I’ve gotten to know well, and we’ve hung out a bunch, and I magically had two hours free on a Friday evening. I drove home with visions of happy hour and fun…in reality I played with my dog, cleaned my kitchen, and caught the first half of a new murder doc on Peacock. Yes. That’s where I’m at age 38 when I snatch two hours free.

I wrangled the boys to bed and stayed up too late finishing the murder documentary. We were scheduled for a playdate the following day which they were very excited about. This was also day seven since son number 1 got the stomach bug. I was so naive. So innocent. Thinking I was in the clear with son number 2.

I woke to son number 2 screaming and running down the hallway to my room. At 1 AM. Once I realized no one was dying and his stomach hurt I walked him into my bathroom and we sat on the floor because he was now insisting he was not going to puke. But I was still waking up and very confused by the screaming and not puking stomach ache.

He’s also crying and tells me his long sad story. He woke up and also woke up his brother, and “I asked him to go get you Mama, and he wouldn’t! He said No! He told me to go back to sleep because if I’m sick we can’t go on the playdate.” As he finished that sentence he puked. A lot. On the bathroom rug. In between heaves he was hitching his breath, crying, saying, “But I want to go on the playdate,”

I’m not the best without sleep. I’m not the best when I’m woken up from sleep. So I was still back on the screams that woke me up, why did he have to scream like that? My heart was still racing and my adrenaline was pumping. I rubbed his back and waited for the puking to stop. I also was thinking about our new carpet in my room and the hallway. I didn’t want to risk puke on the new carpet. This all makes me sound like a horrible mom because I was definitely more focused on the screaming and the carpet then on my puking son.

When he stopped he stood up, and asked to take a shower. Good, yes, into my shower he went. There was a lot of puke. I could not fathom dealing with it. I also did not want him leaving my bathroom and puking on the carpet. My bathroom is freakishly large- like as big as their bedroom- so I went and got his sleeping bag and pillow, and the meat scissors from downstairs and a garbage bag.

In these moments there was no future thinking. There was only survival and the quickest way to get him back to sleep and ultimately me back to sleep.

When I walked into their room to get the sleeping bag his brother rolled over and muttered, “Did he puke?” “Yes” “Well I can still go on the playdate!” then he rolled back over and fell asleep.

I used the meat scissors to cut the area rug in the bathroom. I cut the puked on area off. Put it in the trash bag. Lysol wiped and sprayed the entire area. Laid out the sleeping bag on the rug with a puke bowl, and now clean boy crawled in and fell asleep instantly. He actually told me he was happy he could sleep there so he would be close to the toilet. Not that he ever puked into the toilet. But he had good intentions.

He and I were both exhausted the next morning. And both boys were fixated the canceled playdate. All. Day. Until I rescheduled for next week and we have now been counting down to our make-up playdate. Cross your fingers. Everyone stay healthy.

The rug looks like some one took a bite out of it. I pondered my frame of mind as I was reflecting on my 1 AM decision to cut the puke part out of the rug. I tried to make sense of this decision. I think it made a lot of sense around 1 AM when I wanted to get back into bed, did not want to spend two hours cleaning a rug, and definitely did not want to touch the stinky puke. Then I remembered about him asking his brother for help and his brother refusing!

I went and confronted the brother. So he asked you for help and you said no? That was not nice. Please do not do that again. He shrugged, “But the playdate.”

This. Is. 7.

The Rug

lesbian mom · mom of boys

Emotional Intelligence & Sons of Single Moms. (It’s me. I’m the single mom)

There are so many times a day where I think to myself what am I doing as a parent? Being a single mom has put my parenting into sharp perspective. I can’t help but examine, question, and judge my parenting because I have my sons most of the time so it feels like everything about them is a direct result of me.

There are studies (because obviously I have poured through academic journals searching for data on single mom families) that show children of single parents- specifically sons- have higher emotional intelligence than sons of married parents. I’ve wondered about this finding before being a single parent but now I get it. Let’s take a few weeks ago, for example. It’s sucked. It started sucky and ended worse. Crisis after crisis with my clients. Significant illnesses and life events occurring.

I was in contact with seven therapists about seven different clients before Tuesday end of day. It didn’t get better on Wednesday or Thursday. Hospitalizations and other high acuity referrals. I spent karate class on Thursday outside on the phone with yet another therapist about another client and had to make a rather gut wrenching decision in that moment.

Then I had to bring my kids home, chart some more, make more phone calls, then also make dinner and sit with them at the table. When they came into the kitchen they asked if I was okay. And honestly I wasn’t. I was sad, defeated, and if I had a partner it would have been my tap out moment. I would have tapped out and gone to the store or a yoga class or anywhere but staring into my kids eyes as their only source of everything.

I felt my eyes well up and I blinked back tears and said, “I’m actually having a really hard week baby, and I’m really sorry if I’m sad right now I just treat a lot of patients and sometimes they can be more sick and need more of my energy. And that’s how this week has been.” They looked at me and then murmured some I love you’s and then one of them offered to bring the dog out for me and I said sure and thank you.

I put dinner together under their watching eyes and they set the table, and when I asked who would feed the cats they didn’t fight about it…like they do every other time. And when I went to sit down one of them came and hugged me and said he loves me and he’s sorry I’m having a bad week. I smiled and told him I was having a great week with my sons. It’s just work this week that’s been bad.

You see there is no way sons and daughters of single Moms can avoid seeing their parent be emotionally vulnerable. We do not get to hide it. We do not have a tap out option. We still have to be present and if we are going to be present and stressed I have to explain that it’s not them I’m stressed with; that it’s something else. Being a single mom is really shitty in those moments but it’s also very powerful. I am incredibly private, in my line of work especially it’s legally required to keep it private, but I have been forced to open up about some of the emotional toll it takes on me to my sons because they spend so much time with me and only me.

I’ve had to explain that I need to do a yoga on IFit tonight because I just need to clear my head because I’m having a hard day. I’ve had to explain why I’m still working after 6 some nights because one of my patients is sick and I have to help them. I’ve had to apologize some times for maybe an irritable reply and go and tell them that was not about you that was about me being overwhelmed right now and you busting into my home office asking me to settle a fight between you and your brother which was poor timing and a poor response by me.

Being a single mom has forced me to do better at apologizing. It’s forced me to do better at taking space and taking even five minutes for self care. It’s forced me to set better boundaries around my working hours and around my clients expectations of my availability. But it’s mental health and I own the practice. Sometimes there are crises and I have to deal with them during family time. I do keep dinner time sacred. No phone, no laptop, no distractions. Sometimes that means we eat late.

Recently one of my clients was telling me how they wanted to stop caring about their work because then it wouldn’t hurt so much. I told them that’s what makes them good at what they do- their compassion. I try and tell myself that. It’s because I care about my clients that weeks like this with this level of illness and crises and decisions guts me. But that’s why I still love what I do. Because I do care. That’s why clients have stuck with me now for close to ten years. Because they know I care. Deeply.

If I’m teaching my sons anything I’m hoping it’s that it’s okay to let others know how you are feeling. It’s okay to feel sad and hurt because of external stressors. It’s also okay to take responsibility for your actions and link them to feelings. I’m hoping they learn what it feels like to be nurtured and then to also nurture in return. The only way to teach emotional intelligence is through example. I’m hoping my example is enough. I’m hoping I don’t lean on them to hold my emotions. And I hope they are learning a solid work ethic and approaching work with passion and compassion.

But if I tried to read this to them or discuss this in any way they would probably both fart and laugh. Which I guess is also reflective of normal 7 year old behavior which is a good thing. And last night when I had banned screens for some behavior we played Trouble and laughed and after the 45 minute game…yes 45 minutes…one of them looked at me and said, “I had so much fun tonight Mama. I love you.”

lesbian mom · mom of boys

“I Used to Have Fun…” A Mom’s nostalgia.

There’s this scene in Mamma Mia where Meryl Streep looks wistfully at the sky in her overalls as she wanders around doing repairs and paying bills and says nostalgically, “I used to have fun…”. The context being her 20 year old daughter is there with her friends and they are having fun.

When I first saw Mamma Mia I was 23 and…I was having fun. Honestly I started having fun when I was fourteen. I partied hard in high school. I actually partied less in college than high school…not to say that I didn’t party though. Then my 20’s, well the first half of them, was freaking phenomenal.

I know this sounds bad coming from a mental health professional- but in this post I’m just a woman. And I don’t regret one freaking hangover or bar fight or spontaneous dance on a stage with two gay boys who totally choreographed with me in my hat…because I had a good freaking time.

Then my 30’s came along and boom. Kids. Dad died. Divorce. Kids. Work. Kids. Work. It became super un-fun. Okay well still fun, in very different ways.

My 20’s were filled with pee your pants laughter. And not because I had a weak bladder due to carrying twins. But because the shit I got into was that hilarious. Especially when we filmed it. Which we did. Often.

I still don’t regret any of it. I don’t regret falling on my butt in an icy parking lot in front of about 100 people on my birthday after drinking prosecco with some of my best friends at the time and then sliding on my stomach over to my friends car because I was too scared to try walking again. I don’t regret filming me and another nurse in the bathroom at a staff Christmas party doing…well things…and then going out to show literally every one at the party…I don’t regret the many times I went skinny dipping-everywhere I could-, and the dancing. All the dancing. OH and even that time I fell down the stairs, didn’t drop my drink, and then yelled “Lesbian sex is awesome” in the middle of the gay bar.

I don’t regret the five years of attending the “herbal conference” in New Hampshire where we brought tents, danced around a fire, ran through the woods and the lake and “studied herbs”. We were told repeatedly we could not dance or swim naked. That place was wild.

Right now my life has less raucous fun. And it has less people in it who I had that fun with. Which sucks. But se la vie right? People move. Friendships change.

There is fun and laughter now but different fun and laughter than in my 20’s and I am damn glad I had my 20’s to make me into the somewhat serious 38 year old whose eyes twinkle with restrained laughter when my 20’s clients tell me about their hijinks. Because internally I’m like…I got you beat.

And that pee in your pants fall on your butt dance on the stage 20 something is still in me. Waiting to re-emerge when I’m through this serious Mama phase.

When I first saw Mamma Mia I remember identifying more with 20 year old Amanda Seyfried. Falling in love. My future ahead of me. But now at 38, I saw Meryl Streep say that line and I was like damn. I feel that. When did I become the parent in all these movies of my youth? Age 30 and 11 months. That’s when.

I spend my days treating the mentally ill and supervising employees. I spend my afternoons, evenings, and weekends parenting two seven year old boys. Not a lot of time for raucous fun. I spend it dealing with school about whichever boy is not listening this week or acting up on the bus or presenting at the assembly. I chauffeur to karate and basketball. I became this Mom Boss lady and while I love the confidence and not give a fuck attitude that my 30’s brought I can’t help but every so often stopping in the midst of a moment with the boys and thinking wistfully to the Summer fling when I was 22 that led to an embarrassing I don’t remember you moment when he moved in with a friend…or the Halloween parties, or, well everything wrapped up in that moment “I used to have fun….” because yeah Meryl. I feel that. Hard.

There was also a stripper.

And sharp-ied mustaches.

I think the dancing on stage with the gay boys was the best though. I think they were actually getting paid to be there and I sorta hopped up with them and we all gelled so the club people let me stay. It. Was. Amazing.

Halloween NYU. Epic.


Nurses & Trauma Bonding

A friend from the emergency department opened a witchy store right near my office. I had messaged her and told her I’d come by and get some gift bags for an employee dinner coming up that I’m giving for my employees. So I went, I brought the boys, I hadn’t seen her in several years, but I got the gift bags, the boys had fun, and later that night I was with a friend at a sushi dinner.

I told her and her husband about the witchy store experience and the gift bags with many items that can ward off bad/negative energy for my employees. She asked if I was close to the owner. I said no, not now, but it’s like when you see a kid die together, no matter how long ago it was, there’s a bond there, and it just feels right to support people I worked with in the ED. My friend is also a therapist of course, so she says, “Oh, you guys have a trauma bond,” and I am also a therapist in my psych nurse practitioner way and I sorta nodded like, well yes. Yes we do. Then my friend did the therapist head tilt and I was like shut it off. We don’t therapize over sushi.

It’s hard to describe a trauma bond. But if you’ve had one, you know. I didn’t like everyone I worked with in the ED. I worked there for seven years. The last year being roughly ten years ago now. And I know for sure not every one who worked there liked me. I get it. I can be a lot. But, and this is the trauma bond part, if I was walking down the street on the coldest day of the year- around here that can be below freezing- if I walked into the person I disliked the most and vice versa and I didn’t have a coat and they did and I was shivering and cold they would still take their coat off, give it to me, and try and help me get warm. And I live in a generally unfriendly state…no one else is going to be stopping to give up their coat. Trust me.

I know some of them are reading this. And I know they may be thinking of certain people thinking no way in hell, but really think about it. Any of us would give the shirt off our back for some one we stood next to while a kid died. Because it wasn’t just about the deaths. It was about keeping each other safe. Holding each other’s emotions. And the causes of death. The abuse cases. The sudden arrests. The police. The assaults. We held each other up through some crazy heart breaking cases while being pushed down on by management and being told there is no room for raises while the board gets million dollar+ bonuses.

That’s what bonds us. The chronic stress. The vulnerability. The rawness. The night shifts. The affairs. We know a lot of stuff about everyone we worked with. A. Lot.

If hospital systems embraced these bonds, acknowledged them, and honestly if they manipulated them, they could have the most loyal and lifelong employees possible. Instead they just keep pushing nurses down and eventually we break and leave.

Being an employer has taught me incredible lessons about myself and about employees. I’ve learned that anxious employees are amazing. And I say this for many reasons and with complete love. Anxious people tend to want to please. So they get their notes done, they drop their charges, they show up for sessions early, and if they have to cancel I know it’s for a solid reason without them even telling me. They are very hard working and get everything done that needs to be done. I’ve also learned that I make anxious people nervous and I have to use a filter and work really hard, to…well to be less myself with them. Because they’d all leave if I was direct and myself.

I had a short exchange via chat today with an employee, and I was in the middle of a phone call and four other things, so my answer to her was short on the chat. Not short rude- just my normal shortness- to the point, nothing extra. I had to pause. Go back. Write a longer message explaining I was in the middle of five things, it’s me not her, I’m not mad, etc. type of message, and I got a response “Thank you so much for that, you saved me an afternoon of ruminating about this.” Five years ago. Before employees. I would never have sent this follow-up message.

But I’m never too old to learn. I have always said and will continue to say I want to be the boss I never had. I had to expand that to say, I want to be the boss you never had either. Because the people who work for me are not me. I have to approach everyone as an individual and recognize their strengths and weaknesses and anxious people- freaking phenomenal employees who need more reassurance than I am used to or was comfortable giving. It’s been a learning curve. But damn if I can figure out why the heck can’t large hospital systems?

I can only hope my employees won’t leave their work tenure with me with a trauma bond. Just a fun, friendly, co-worker bond. The work we do is hard enough. We shouldn’t be traumatized by our work environment because of our employer.

To all you ED nurses creeping on my blog- the term is Trauma Bond. Get a therapist. They can handle your shit. Trauma bonding can be intense maybe intoxicating for some. But it messes you up. You know it. Get help. There is no shame in mental health help. Therapy helps. I’ve been on both sides.

Divorce and Separation · mom of boys

Parenting Twin Seven Year Olds…The Good, the Bad, and the Ugly (and basket-ball).


When the boys were five months old I remember sort of stumbling into morning rounds a couple minutes late and the Attending looking annoyed as he continued through the patient list. I mentally replayed my morning up to that moment at 8:35 AM.

I was up from midnight to 2 AM nursing both boys. Then I was up at 4 AM. For good. Nursing them. My ex left the house at 6 AM and there I was. Trying to get ready for work, making myself look human, while also getting two babies dressed, fed, and out the door. I remember it started raining just as I opened one of the back passenger doors in the daycare parking lot. I carried the two car seats with two five month olds, and stood in the rain as I buzzed the daycare door to let me in.

Those were some damn hard days and nights. But in some ways they were easier than the parenting I do now a days with two seven year olds.

These boys, man. On the way to basketball on Saturday. We had already had a morning. Because there was a lot of not listening that occurred so I was heightened in terms of my ability to tolerate any further nonsense from them. There I am. Driving on a main road and the seatbelt light flashes and I yell the offending child’s name. “Dude, seatbelt!” “But I dropped my Nintendo Switch!” “Well grab it and put your seatbelt on” … seconds go by. The car starts doing that obnoxious ‘You don’t have your seatbelt on’ beep and I’m like “What is taking so long?!” And then I hear some talking back in the form of under the breath muttering and he’s thinking he’s slick, and I’m just done.

I pulled over to the side of the road. It’s a narrow main road with not much of a shoulder. So I basically took up half the road. I stopped. Put my flashers on, and dared any drivers behind me to come mess with me. I turned around to face my children and waited in silence as he finally got his seatbelt on. I put my hand out for the stupid Switch and then tossed it on the seat next to me. Waited for the cars to pass and then pulled out to resume our journey.

He leans over to watch his brother on his brother’s Switch. I hear the critique start. Because brother without the Switch feels he knows how to play better than brother with the Switch. There is some bickering and then brother without the switch and the seatbelt offender says, “What the fuck?!” He did use it appropriately in context as he questioned his brother’s move which did lead to his brother’s death in the Switch game.

I pulled over again. Turned around and talked about appropriate language, and he was apologizing, and then we are on the road again. I’m not sure he was actually sorry, I think he just wanted me to start driving again.

We make it to basket-ball miraculously all in one piece. Basketball is a ten minute drive from my house. This was ten minutes of my life with twin seven year old boys.

Today I spent the morning trying to decipher the $8.25 charge on one of the boys accounts at school. The boys bring their lunches and eat breakfast at home. There should be a .75 cent charge for the ONE chocolate milk I was asked if he could purchase last week. I look closely and discover not one chocolate milk charge but 11. The boy had chocolate milk eleven of the last twelve school days.

When I talk to him in the afternoon he looks exhausted before we even start, and I ask what’s wrong and he says he had a hard day because a girl made fun of him, and called him a name “lots of times” and he asked her to stop and she wouldn’t. Then he’s crying. So we process another kid being mean, and then I still need to talk to him about lying about the chocolate milk. Which I do. He feels bad. He feels worse when he realizes he’s going to be paying the $8.25 for all the chocolate milks. He feels even worse when I tell him that on top of paying he is going to be doing firewood runs with me every morning this week.

I’m not trying to kick him when he’s down, but he still has to own the lying about the chocolate milk. There was no yelling. It was a calm discussion with hugs. But damn that was a rough fifteen minutes of my parenting day.

So that’s what I mean when I think back to when they were 5 months and my worst problem was carrying two babies, nursing two babies, and trying to stay awake for work…because now adays I have these two people. Two people who say things like What the fuck?! Two people who lie. Two people who hit each other and pick their noses. Two people who feel such big feelings and who look to me to contain them, hold them, and love them.

This Saturday at basket-ball, there was the whole countdown at the end of the game and the crowd joined in and my What the Fuck son got the ball and dribbled down toward his basket, and we were at the “THREE TWO…” and he threw that ball up there and nailed the shot right at ONE. The crowd went wild and his teammates, including his brother were grinning ear to ear and slapping his hand and back, and he shoved his hands in his pockets, turned and walked away from his basket like he was just going for a stroll, and he tilted his little head over toward me and made eye contact and I smiled and clapped and he did a little smile and kept walking.

It’s those moments that I live for. When my kid looks for me because he wants me to be watching. For all the parents missing those moments- you’re missing out. Because even in the worst and hardest moments of parenting, it’s those moments when you know they want you to be here, by a little side eye and a smile, and if you’re absent you’re missing it. And I wouldn’t miss the What the Fucks?! Just like I wouldn’t miss the heroic buzzer shot. I want to be there for it all.

And I want my kids to want me there. Because that’s one of those warm gooey feelings that lacks definition. As a parent you want your kids to want you around and those moments when you can see that they do…are few and precious and keep me going through those horrific ten minute car rides.


A Note on CPR ***Triggering re- CPR and death.

I don’t watch football. It irks me for many reasons. 1- Doctors and nurses save lives every day and we will never make millions of dollars per shift. While I do not fault pro players for working hard and pursuing something incredibly difficult, I do no think it is worth the millions they are paid. 2- When I see people riding motorcycles without helmets I have a visceral response because I think wow. You just want to die don’t you? And/or you are a complete idiot. Playing football…sort of the same reaction. I worked in a pedi-ED for 7 years and the worst injuries were football, hockey, and skiing/snowboarding, and the surprising fourth place would be cheerleading. These were kids. Sustaining serious injuries. The fact that we KNOW that long term head injuries causes chronic traumatic encephalopathy and yet people still PAY to see these men literally cause brain damage to themselves…well it’s sick and fucking twisted in my opinion.

So when I heard about a football player falling down cold and requiring CPR mid-field and the subsequent fallout. I’ve had a lot of feelings about that. I think people having the most feelings are people who have performed CPR. You can’t see me, but I’m raising my hand. I’m that person. I’ve performed CPR. And honestly, I lost count of how many times I have done it.

The feelings I’ve seen from my fellow critical care healthcare providers on social media are a mix of things including but not limited to: we are not paid enough for what we do and it’s ironic that the million dollar employees on that football field had no ability to save their teammate and it was the 20$/hour EMT’s who saved him. The NFL and the world has taken a pause after being traumatized by watching CPR performed. There is acknowledgement that watching and performing CPR is traumatic. I can tell you, of the several times I performed CPR or rescue breaths I never got a break afterward. In fact I would be reprimanded if I tried to take one because “Everyone is feeling it and they are all back covering patients. Pull it together.” Was said to me when I was found crying in the med room after the unsuccessful resuscitation of an 11 year old. Unsuccessful resuscitation sounds too pretty though. This is what really happened.

I straddled a kid and pushed in and out on his chest with sweat pouring off of me, no gloves, no mask, no idea why he was here, he was carried in by screaming parents and me and another nurse threw him on the stretcher. She started breaths. I started compressions. She and I passed glances as the rest of the team surrounded the bed. I could feel his ribs bend under my hands, and I had to keep a fast pace. It was the end of night shift and we were all fucking beat. We were also short staffed. I also had three patients who were freaking ill that I knew needed me but here I was. Pushing on a chest praying this heart would start. But there’s a particular smell of a dead body. You learn it after working critical care. We all knew it. We all smelled it. He wasn’t long dead, and young enough we may get a heartbeat back, but he was gone. The heart beat would be so the parents could have time to wrap their minds around organ donation and brain death. I knew it. The nurse at the head knew it. The doc knew it. But there I sat. Pushing on his ribs, hearing the parents scream and cry, and after fifteen minutes, three rounds of epinephrine the doc called it. You ever hear parents when a doc calls their kid dead? It’s about as awful as you can possibly imagine. There was a thud as the Dad fell to the floor. The mom keened a sound like a horribly wounded and dying animal. And I slowly climbed down trying not to look at the kid because I knew I had three more waiting for me outside the door.

I wiped a stray tear and walked past the dead child and the grief stricken parents. I walked into a room with a kid with pneumonia. I looked at her chest. Rolled my eyes and said “Fuck.”

Grabbed the bag and started pushing air into her lungs. She was on the monitor but for some reason it didn’t pick up that she wasn’t breathing. Her oxygen level was still perfect so it must have just happened. She was warm and pink, but definitely not breathing. The doc walked by saw me bagging and said “Oh!” and helped me roll them into our resuscitation room. I bagged her until she was intubated and brought up to the ICU. Then I went to try and give report to the day shift nurse who was pissed I hadn’t hung the antibiotics for the other patient.

I could barely even speak. I remember just rubbing my head and saying I’m sorry and going to get the antibiotics and hanging them and going home. That night was Christmas Eve.

I went to my family’s traditional get together and pasted on a happy face and pretended I hadn’t had a horrendous shift that involved CPR.

So you see. That was one time. One time out of many. Healthcare professionals are not given the support, the time, the space, or any ability to not be traumatized doing our work. I didn’t get a bonus when I saved people’s lives. In fact my clinical skills had absolutely no bearing on my raise each year. It was based on patient reviews and emergency department numbers and benchmarks. So if anything comes from this very public display of CPR I hope it’s 1- Respect for the goddamn skill that critical care healthcare workers possess. Because I’ll say it- we are a fucked up little bunch of people- but damn we know how to save lives. 2- Acknowledge that football is fucked up. 3- Healthcare providers NEED and should be REQUIRED to have access to the time, space, and resources to heal after a traumatic work event which SHOULD include any and every time we perform CPR.

To any Healthcare Providers reading this- for your own knowledge- after I left the ED I saw a therapist for about two years and did a lot of EMDR therapy with him. It changed my life and allowed me to heal from all the trauma of the ED. Our focus was on my memories from working in the emergency department as those were quite traumatic for me, but I did not even realize it until after I left how messed up I was. When you are functioning in chaos it’s hard to see how heavy it is until you are out of it. Exposure therapy and I think any kind of therapy can be scary for critical care workers- I know we are a tight little bunch who don’t trust outsiders to be able to hold our shit. Because it’s heavy. But I promise you there are mental health providers out there (Myself included!) who treat first responders and are not intimidated by our shit. Do not let yourself go untreated because you think we can’t handle it. We can. Hospitals will never prioritize your mental health- you’re going to have to take the steps on your own. And for that I am sorry. I am sorry we work within systems designed to demoralize us. But I see you, and I appreciate you, because I am you.


Ten(+) Things I Have Learned Living in a Farm Town.

I’ve learned many lessons in the five years since I moved here. I grew up in a suburban town that I thought would be similar to this small rural town. There are similarities, but also significant differences unique to rural life. I’ve written and re-written this post over several months. There was a section about guns I am editing because that can be a separate post.

  1. On the community Facebook page- when people post pictures of cows or horses that are in their backyard with the caption “Did some one lose a cow?” They are not joking. There will be a flurry of responses and tags e.g. “John Smith looks like Betsy…?” “Maggie Smith tell John Smith that looks like Betsy” Eventually John or Maggie Smith may pop on with a picture of Betsy home safe and sound in her barn and many thanks to the community for helping them find her. I did not know people could lose horses and cows. But they do. More frequently than you would think. Vice Versa people post pictures of animals that are lost…I have been credited with identifying a lost duck and hens that were in the wetlands area across the street from me. A thankful owner drove up in their van within ten minutes of me replying to their “Lost duck” post and hopped out and retrieved the duck and hens.
  2. I can be friends-ish with Republicans. It takes a lot. From both sides. And let me qualify this with a hell no to Trump Republicans. But if I didn’t at least play nice and polite with some Republicans…well that cuts out about 4,000 people of the 7,000 total. Of note Biden won by 8 votes in the last presidential election in this small town- which gives me some hope.
  3. I have to work harder to find my people and the families I want the boys exposed to. It’s not impossible and I’ve met some incredible people and amen for the other lesbian couple in town who have boys the same age as mine. I also have attended some of the town Democratic committee meetings which helps.
  4. In that vein- I have never lived somewhere with a majority Republican government and I am continuously impressed with the persistence of the Democratic committee. They are never defeated even as they are always defeated. They show up to all town meetings and enter candidates into every election possible. I have come to truly admire their dedication in a seemingly hopeless town populace. They have also taught me the importance of Democrats showing up even when there is Republican majority.
  5. You will get stuck behind tractors while driving. You will also know multiple people who own tractors. There will be many discussions about said tractors, as well as rides on them, and inevitably one of them will have a tractor that has no brakes. This will be a known fact and yet people will still use the tractor. With no brakes.
  6. You must have a generator.
  7. Farm towns have significant racism and homophobia. What’s interesting though is that most people are still willing to have a conversation with me and be neighborly or friendly. There are hateful people. Make no mistake. But there are also people who will in this rough shodden sort of way be accepting of me as a person. I had a client once who had a neighbor who was transphobic and after a few caustic interactions they ultimately developed this bizarre friendly banter that I now understand. Every morning she would walk out for her paper and the neighbor would be working on his car and he would look up and wave and say with a grin, “Morning Tranny,” And my client would respond, “How ya doing you bigot?” Then they would both laugh with neighborly affection. That is the best way I can describe farm town life. It’s like we know we are all different but there is also this loyalty that develops and protectiveness among people who live in rural communities. I’ve been forced to challenge my own black and white thinking around human relationships and differing political belief systems in big and small ways.
  8. There are incredibly indigent people in farm towns. People who are suffering, whose homes don’t have working heating systems, and who are food insecure and housing insecure. I volunteered administering COVID-19 vaccines in town last year to homebound individuals. I saw incredible poverty in some of the homes I visited. But also strength, dignity, and pride. It was an eye-opening and humbling experience for me. There was poverty in the suburbs I grew up in, but not like this honestly.
  9. I can’t let my gas tank get as empty as I used to because I won’t make it to a gas station. We are not in the middle of nowhere per se but it takes a few miles to find a gas station. And at least ten miles to find a grocery store. Traveling a minimum of 20 minutes to a grocery store was a new experience for me. I do not like it.
  10. Growing up on the shoreline I was used to salty air, salty breezes, and generally a fresh feeling from the water. It is still weird not seeing the water every day. But the longer I am here the more I have leaned into the woods, the open fields and valleys, and what my cousins who are geologists refer to as “elevations” but what the locals call mountains. They are petite mountains. There are beautiful sunsets over the valley, and I’ve traded the nasty smell of low tide for the warm wafts of manure in the Summer time. There are cows a few houses down, and ducks and hens the other direction. Horses across the street. The landscape is hard to beat and I understand why people stay. It’s a rough sort of beauty that creeps under your skin. After being away for a few days this past weekend I drove through cities and suburbs to get back here, and I breathed this sigh of relief as I saw the haystacks and the tractors. Then I thought there was something wrong with me for being relieved by haystacks.
  11. I have a friend from Wyoming, she lived in California and now on the East coast. She says there’s a saying that people on the West coast are nice and people on the East coast are kind. Meaning, on the East coast and especially in New England we are likely going to be rude AF to your face. BUT…with an annoyed sigh or no eye contact at all we will hold the door for you, and we will dive into the street when you drop something and then yell at you as we run after you to give you the dropped and recovered item. Kindness with a gruff exterior has never been more real to me since living rural. People who may be seen as “mean” have helped me drag Christmas trees to my car and house, and they have helped me stack and cover firewood the day before a hurricane came, they have shown incredibly kindnesses to my sons and I in many ways. I get warning texts about bobcats and coyotes from the neighbor who once argued with me about the sense of putting a BLM sign in a town “Full of white people”. I have found that as long as I don’t overtly try and change any one’s opinions but firmly stand for my own…we find this central sort of peace. I have experienced true kindness in a town that is about 1/3-1/2 homophobic.

I moved here five years ago. And especially after the divorce I thought I would leave. But the longer I stay the harder it is for me to imagine living somewhere else. The love that people have for the land here is contagious. And the loyalty among rural neighbors is hard to describe and not truly appreciated until you experience it firsthand. In a liberal state I never expected to land in a majority Republican enclave. But it’s made me appreciate the drive and fortitude of the Democrats who are here so much more. I thought that maybe I’d have to compromise who I am to live here, but if anything it’s cemented who I am because while others may have different beliefs there is still a level of acceptance of me and what I stand for because there is admiration of the fact that I am standing for something.

Since I moved here I see a rainbow every Spring and Summer. Usually two or three. In fact I’ve never seen so many rainbows before I moved here. I’m taking that as a sign that I’m where I am supposed to be. And who knows? Maybe along the way some one’s viewpoint will shift and that by me being here the next presidential election the democratic candidate will win by more than eight votes.

p.s. We didn’t know Biden won our town until three days after the election because the registrar and town clerk were both out sick and we had to wait for them to come back and count the “boxes in the office” for the final count. Yup. That happens apparently in rural towns- boxes of ballots in an office that only one person has the keys for.

p.p.s. I am looked down on for paying for a trash service. Apparently we are all supposed to bring our trash to the dump and then complain the dump is only open banking hours.

I searched the town FB group…this was the first of MANY in the “lost cow” search results
mom of boys

Christmas Without Christ

I grew up going to church. Until I was confirmed and somewhat older and realized there were a lot of holes in this Christianity situation.

My ex was raised in a more conservative and cult orthodox church. So when we had kids, we were both fine with not bringing the boys to church. I did like the community aspect to church and the community support. Growing up we became very close with many members of the church- I in a healthy way, my ex in a cult-like depend on us and only talk to us and no one else ever type of way- but regardless- it provided connections to people.

In terms of the holidays it provided context and some structure and fun events. There was always a kids pageant and then an adult run nativity pageant that was done outside. With real sheep. The sheep got loose one year. My Dad was a Shepard. It was hysterical.

Now I’m raising boys who have never been inside a church. It’s weird. They ask random questions about God and I try and explain and it usually devolves into us getting into a fight about whether God is a man or woman. I had finally sort of explained a genderless concept of the Christian God. Preface to this next bit- I also had explained sperm donors and that you need a piece of a man and a woman to make a baby. Trust me that is important.

Up goes my nativity scene that was handcrafted by my Dad (who died in 2019). I am looking at it rather nostalgically and one of my sons asks who the people are. I start to explain the story of the birth of Christ. It went something like this, “In the Christian religion there is a story of the son of God being born. Christmas is the celebration of the birth of the son of God. Mary, right here, is Jesus’ mom. Then Joseph is his, well, sort of stepdad I guess, and then these are the wise men, they are three kings who travel far to see the birth of Christ, and then here are the shepards with the sheep, and they all meet up in a stable where Mary gives birth…” “But why do they have to have a baby in a barn?” “Well there are many people, bad people, like bad kings, who are threatened by the birth of Christ so they are kind of in hiding, and there is also no room for them anywhere else,” “Bad kings like Donald Trump?” says one of my sons. … “Um, I don’t think I have ever described DT as a bad king…so kind of not like DT, but, okay, so then,” “So Joseph is the dad?” Me- “Well no, Jesus is the son of God.” “But Mama, you told me that God is not a man.” Me- “Correct.” Skeptical eyes regard me, “So if God is not a man and you need a piece of a man to make a baby then who is Jesus’s Dad?” … “Um here’s your stocking. Why don’t we hang up your stocking?”

Apparently Christianity understands how whacked their story is because they prefer to indoctrinate people from birth. Because my kids questions were all totally solid. And honestly, if you’ve read Mathew, Mark, Luke and John, well the whole birth of Christ story is a bit hodgepodge. One linear narrative would have been very helpful. And the whole “The spirt of the lord came upon her” is just not a satisfactory explanation to a seven year old and in fact is kind of creepy post the whole #metoo movement.

I never thought the story of Christ was creepy before I had to explain to a 7 year old boy though. I also never thought I would have to be the one explaining it. I guess I assumed I would raise my kids in a church. I don’t regret not doing it but it makes religious based conversations rather challenging. There are concepts and storylines I just accepted because I was raised from birth hearing them. But when they are being explained for the first time perhaps at age seven…when I’ve spent the first seven years educating them in a very logical, science based, concrete way…well it gets interesting.

I’ve tried comparing God to Santa Claus- not that God is like Santa Claus, but that we believe in Santa and we have faith he exists, and that’s sort of how people feel about God. That we have no evidence He exists but that many people have faith that He does. “But Mama, you said He’s not a boy,” “I did say that yes, I just revert to calling Him ‘He’ sometimes because that’s how it’s referred to in the bible,” “So He’s a boy?” “Well no, He was written about by boys though in a way to subjugate women, so it makes sense that they gave Him a more masculine presentation…” Then they stare at me.

Listen parenting is hard. Explaining the concept of God to an adult let alone to a black and white concrete thinking 7 year old….it’s rough. There is a part of me that feels they are missing out on an experience by not being raised in a church. But it also feels hypocritical to partake in Christianity when I believe it was a religion made for very political purposes and the holidays are clearly based off Pagan holidays and paganism was women driven. I probably should not have attended a religious college because the deeper I studied religion the more skeptical I became.

If my kids grow up and attend church and engage with religion though I will support them 100%. Unless it’s one of the cults. Then I’ll be moderately irritated and likely have to infiltrate the cult in order to produce an expose documentary which will include saving my children from the cult.

In the meantime I do the best I can piecing together the stories of Christianity, interjecting Pagan traditions, and trying to educate myself further on Judaism. Because enter a discussion about Chanukah. “Mama, can we celebrate Chanukah?” “Well we generally don’t because we are not Jewish.” “But we don’t go to church and we celebrate Christmas.” …. Touché my children. Touché. I have a year to study up. I told them it would not mean more presents. They seemed okay with that proclamation and were more focused on wanting to see a menorah lit up.

This year I anonymously ‘adopted’ a family of three children from my town and the boys and I went to Target and overfilled two carts with Christmas presents for the three kids. Throughout the store the boys had to be reminded a couple times that we were there to help a family who needed our help and this was not a shopping trip for them. When the total rang up the boys asked if I would have any money left to get them presents. I told them even if I didn’t they should be grateful that we are helping out a family. They helped me wrap the presents, it took awhile, and a lot of gift bags and tape, and a list of what was in all the bags…and then I got an email there are a few tags left that had not been taken. I brought a check with me to cover at least three more tags along with the presents for the family we shopped for.

I did all of this rather quietly but those boys see all. Flash forward three weeks to this morning, Christmas morning, we finished unwrapping our presents and one of my sons said, “Mama, you know those families we helped, I bet they are happy too. And they don’t even know who we are and we don’t know who they are! That’s so weird.” I smiled, and hugged him, and said, “Weird but good right?” He smiled back and said, “Weird but very good. You helped people and that’s what Christmas is all about; that and being grateful. I’m thankful for my family and it only matters that we are together.” And it’s those moments when I think, you know what? I’m doing okay.

Divorce and Separation · politics

“What Are You Looking For?” On Every First Date Ever.

You ever do the dating apps? OH and I had to replace the damn fresh cut tree (yes I also did a second freaking cut when I got it home…asked literally every person who ever has gotten a live tree)…but I’ll get to that.

I’ve talked about my dating misadventures in previous blogs. To summarize: men suck. So do women. My dating experience has been limited to: men who live with their parents, men who are super passive even though it says in my dating profile not looking for passive…because that doesn’t go well with me. Literally had a guy say at a second date “You’re going to have to slap me in the face to make anything every happen.” First off…I don’t even know what that means but I won’t be slapping anyone in the face. Thanks. There was no third date. But there was a text that he thought we could be good friends. Puke.

But I digress. With all the bad dates. And there have been many. Many. I’ve had to think about what would make up a good date. Or perchance a good relationship. Because what I thought was good in my 20’s landed into not good in my 30’s with my ex. So I’ve thought a lot about this. What is a good relationship? And the cliche first date question is “What are you looking for?” I have a response now. I just am not sure that it exists. In one person. Maybe I’ll have to go poly.

I’ve whittled it down to two short paragraphs. The first is from The Line. You ever listen to the podcast or watch the documentary on AppleTV? I’ve done both. Blew my mind both times. Because I normally do NOT side with Republicans. In fact I still feel mind-fucked to even be considering their side. But that’s not really what this is about. It’s about the wife of Eddie Gallagher. Eddie killed an Isis soldier and then was arrested and charged for it. I know. It’s counter-intuitive. He was in Iraq to kill Isis soldiers. But there’s a whole documentary about it- war crimes, etc.

Eddie is generally unlikeable on the podcast- he is more likable or perhaps more understandable on the documentary. But I’m not looking for an Eddie. I’m looking for the loyalty his wife and his brother show him. I mean, talk about a partner having to literally give their all for their partner. I generally find Andrea (his wife) unlikeable. But, even I can admire her tenacity in fighting for freedom for her husband. So when some one asks me what I’m looking for? That. I’m looking for a partner who would move the sun and the earth to fight for me. And some one I would do the same for because I believe in them, in us, so hard that I’d do anything for them.

It’s hard to put that into words though; especially if they have not seen the documentary or listened to the podcast. But I guess loyalty, love, and a fierce protectiveness.

My second metaphor or analogy or whatever is a look. It took me until I was in my late 20’s to recognize a look of lust. I’m kind of dense. It also took me until my late 20’s to realize some one is flirting with me. But now in my late 30’s…I get it…I still may say something awkward like “Ooohhh you’re flirting!” Then they get embarrassed. Then I walk away.

But the point is; I recognize it. It still surprises me because, I’m generally looking exhausted running around with my kids, but I do recognize when it happens.

The other thing I’m looking for in a partner is the look you give and you get when you make eye contact across the room and you just know you want to hop into the nearest closet/car/bed and rip their clothes off. And vice versa. I want to be wanted and I want to want some one else that badly. Some could say passion has led to some bad decisions in my life. But that doesn’t mean I should give up on it. I want the lust as much as the love.

The problem with me saying that to a guy…is they think I want to hop into bed. On the first date. Because as I said…men suck. But so do women. So I’ll be single. With my pup. And my two cats. And the damn Christmas tree.

I got a fake one. The real one died. Literally died. Needles everywhere. Ornament transfer. Dragging dead tree out of house…that’s it. That’s the end. Love. Lust. Loyalty. Republicans. And a fake Christmas tree.

Nursing · politics

A B*&$H About Benzo’s

I watched Xanax on Netflix. It’s a documentary about anxiety and Xanax.

I had a lot of feelings come up as a prescriber.

I think the commentary on the mental health system and race was good and certainly accurate. I think the commentary on why we as a society are anxious is also good/accurate. But it misses why Xanax is a problem.

Benzodiazepines are meant to be used short term. The psychiatrist does say this. She does not go into why though people end up on them long term.

There are a number of reasons; starting with there is a shortage of mental health prescribers. Primary care physicians and APRNs end up bridging this gap. They are comfortable starting some one on Xanax because they are actually taught to do this in school. The line they give is “I’m going to prescribe you a 7 day supply, and give you time to find a mental health prescriber.” Now, it takes more than a week to get an appointment. At my practice we are booking out 2-6 weeks depending on provider. The prescriptions then may get extended and by the time a patient lands in front of me they have been taking Xanax daily for six weeks. As prescribed by their primary.

This is not meant to knock PCPs. They are doing the best they can in the system we exist in. But there is no education about it. There is likely no discussion about what will happen when they see a mental health provider- aka we are not going to continue it daily and we are going to recommend a daily antidepressant medication. And once you’ve had xanax- well Prozac just does not feel as nice. Thus begins a person chasing the “calm” aka “high” that Xanax induces and being really angry at the mental health prescriber who won’t give it to them.

The documentary then spent less than ten seconds on the pressure on prescribers to do what the patient wants. And at the end of the day- that’s what matters- because without that pressure prescribers would have the balls to prescribe safely and ethically. I had to leave a top hospital in our country system to prescribe safely and ethically. Let that sink in. I had to leave a top hospital in the country to be a good and ethical prescriber.

Here’s why.

You ever hear about Press Ganey? It’s a company that puts out those nice little surveys all patients get after a hospital stay. My raise and reimbursement and ability to advance in the corporation was dependent on my Press Ganey scores. Yes, much of my present and future career at the hospital was based on feedback from patients. I worked on an inpatient psychiatric unit and usually half my caseload were hospitalized involuntarily. Then about 1/8 of those people had to be medicated involuntarily through a hearing with a probate judge.

Guess how many of my patients gave me and my team good reviews? Potentially half. The other half, well I was lucky to not be sued by them; which was threatened daily.

Let me tell you a story. Patient X is on Methadone 120 mg, Xanax 1 mg TID, Quetiapine 800 mg nightly, and Lithium 450 mg ER BID. Patient X is admitted on this regimen for depression and suicidal ideation. They are noted at the table in the morning eating breakfast falling asleep. Legitimately falling asleep. Food falling out of their mouth mid-chew.

They are now a choking risk. And within six months of me starting I had some one on Methadone choke, and need to be resuscitated due to their airway being completely blocked. It’s a real thing that happens.

Me being the responsible APRN I am, consult with my Attending MD, they agree, we need to lower their sedating medication especially AM dosing when they are eating right after. We also review the EKG, shows significantly prolonged QT interval- due to Methadone/Quetiapine combination- prolonged QT interval can lead to Torsades which leads to sudden cardiac death. Again- kind of a big deal.

We go sit with the sedated patient, who barely responds to us verbally, and tell them we are going to start tapering their Xanax and Methadone. VERY SLOWLY. We will not put patient into withdrawal but it is unsafe how incredibly sedated they are. Patient mumbles as food falls out of their mouth.

Next day. I walk onto unit. Patient screaming about doses being lowered. Thus begins a very unhappy week for myself and our team and our patient. But. They did not die, they did not have any observable or measurable withdrawal symptoms. And they were able to actually be awake for mental health treatment by 10 AM and engage in groups and therapy. They left on lowered doses of Methadone and Xanax with a lower QT interval and not a choking risk. But they gave me a complete crap review and wrote a novel about how we sucked.

I had to have a sit down with my manager about that case not because of the inappropriate prescribing done by their outpatient team, or the good job in looking out for their respiratory and cardiac health- and preventing another preventable choking potentially fatal situation on our unit- but because I got a bad review. I had to review the chart with my manager and go over the case step by step defending my actions along the way. Amen for my stellar documentation, the withdrawal measures (which were all negative), and the objective data provided by group leaders, EKGs, vital signs, etc. that showed patient had a decrease in depression, decrease in SI, and increase in attentiveness, concentration, and ability to engage in treatment.

My manager wanted me to sign a form saying that basically we had spoken about my negative review. I declined. I requested a meeting with HR. So the cycle began. I provide safe care in conjunction with the treatment team including an MD. I get a negative review. I have a meeting with my manager then with HR. This is not unique to me. This is common among any prescriber working for a corporation that favors patient satisfaction over safe and ethical treatment.

This is not the only reason hospitals cannot retain good doctors and APRN’s. But is definitely in the top three reasons. At least it was for me, and for many of my colleagues.

It is not safe to be a competent and ethical prescriber when working for a healthcare corporation that measures my present and future success by patient reviews- especially when working in psychiatry and addiction medicine.

This does not just apply to inpatient work. It applies to outpatient centers also. My pay being directly linked to patient satisfaction is a problem and the reason I do not work for a hospital corporation any longer. Because working with patients who ran out of their Xanax early, their outpatient prescriber says they are going to be cut off, now I have to forcibly taper them off of it- doesn’t go well for me in my reviews. But that’s part of the work inpatient, and it’s part of being a prescriber. Making tough calls, and especially inpatient working within a team of clinicians to do right by the patient.

So me being ethical and legal…didn’t go so well. And that’s what the documentary failed to expound on. Not only are there these patient reviews- but these patient reviews dictate how much money we make, our performance reviews, and how and if we can advance…and that, my friends, is a fucked up system that invites prescribers to make bad decisions to advance their pay and their careers.

I still get negative reviews on Google for my practice. And they still irk me. But they do not impact my ability to advance my practice or myself. I also can look at them objectively and say, well that patient didn’t get the 3 mg of Xanax they wanted, and got mad, pulled a knife on me- and then wrote a Google review. True story. The google reviews don’t bother me because they do not impact my career and to date they have all been reactive to me setting boundaries and prescribing ethically and legally.

I still have a full caseload, a growing practice, and rock solid clinicians who work for me who know I have their back to be good, ethical, competent clinicians and that I will not let a bad review by an angry patient who we held a boundary with impact their pay or merit or my respect for them.

I agree with the psychiatrist in the documentary when she says benzodiazepines have a place and a time and I am incredibly grateful for these drugs to have been invented and utilized by clients who need them. Because I do prescribe them when appropriate with a lot of education, a urine drug screen, an informed consent form with risks/benefits that the client must sign, and what the expectation will be going forward in terms of treatment.

I have full control over my caseload whereas before I did not. Until our healthcare system changes from a for profit, patient satisfaction oriented system- there will be more irresponsible prescribing and irresponsible treatment. There will also be a lack of retention of prescribers in areas they are needed most such as mental health and addiction psychiatry. The two are linked and need to be addressed nationwide.

*****This blog post covers a very small portion of the issues and dangers of benzodiazepines and is not meant to be fully comprehensive of every issue prescribers face in relation to benzodiazepine prescribing.