#COVID-19 · Nursing

Why America Cried At Steve Burns

I can’t be the only one who wiped at tears at the end of Steve from Blue’s Clues recent video that was posted to Twitter…? In every FB group I’m in from medical based, to illness based, to therapist based, to even a Harry Potter fans group….they erupted with Steve memes, with hearts linked to Steve’s video, and many many of my individual friends posted a tribute to Steve and his video.

Let’s break this down.

America literally lost its shit when a former childhood show star posted a vulnerable, truthful, completely unremarkable video.

It is quiet. He is soft spoken. There is no tension build-up. There is no comedy and no time when he is purposely trying to make us feel angry or sad or anything. So why? Why did an unremarkable video hit our hearts in a way that makes it completely remarkable?

I have some guesses and because I feel like I’m smart and Steve told me I look great I’m going to go a step further and say it’s an educated guess. Below is a rough quote of the video that I re-watched three times and typed while listening to it in order to get the words down.

“We were younger and we used to run around and find clues and do all the fun stuff…and we didn’t see each other for like a really long time. Can we just talk about that? (Pause) Great. I realize that was kind of abrupt. I just kind of got up and went to college. And that was really challenging by the way but great. Because I got to use my mind and take one step at a time. And now I’m doing many of the things I wanted to do. And then look at you, and look at all you have done, and all you have accomplished in all of that time. And it’s just so amazing. I mean we started out with clues and now it’s what? Now it’s what student loans and jobs and families. And some of it has been kind of hard. You know? I know you know. (Pause) And I wanted to tell you, I really could not have done all of that without your help…and in fact all the help that you helped me with when you were younger is still helping me today, and that’s super cool. I guess that I just wanted to say after all these years I never forgot you. Ever. And I’m super glad we are still friends. You look great by the way. Whatever it is your doing. It’s working.”

Reading the words does not have the same impact as watching the video. They fall somewhat flat with Steve’s vulnerable and honest voice and earnest eyes slicing through the horrible bouncy background music.

When I do therapy, as in when I am in the therapist chair, there are moments when I can see I hit the vulnerable spot in a client’s defensive armor. It’s in the moment when I say something that to me can feel like a shot in the dark but I know I hit it when their eyes well up as we maintain eye contact and they nod without speaking and I just named something that let them know, “I see you.”

Steve Burns literally just did that to every kid who grew up watching Blue’s Clues. Even if you hated the show. That two minute video he said, “I see you, and it’s hard, and you’re great.” In a way that we yearn for every day but often lack in receiving. Steve saw us. He let us know with sincerity that he sees us because he is us. He has student loans too. He went to college and gets to use his mind and do all the things every day he wanted to do. And he did it with us, for us, because of us. He says you helped me accomplish things and you still do and I’m grateful for you.

He called us friends still. And told us we look great.

Why did America lose it’s mind? Why did this bring tears to our eyes? Because we lack validation in our every day lives. Especially in the last year and a half. Our lives have been thrust into complete uncertainty. As a parent we don’t know if our children are safe anywhere. We don’t know if we are remote or in person for work, appointments, and school. We don’t know if we should go to the grocery store. We can’t see our families and our friends. We are isolated. Nothing feels right. Everything feels scary.

Steve came in and in two minutes let us know that he gets it. He gets that things are scary. But look at all we’ve done already. Look what we are capable of! Look! Because I am looking and I SEE YOU! Why is Steve Burns the first and only person who has been able to penetrate the “scary” of the last 18 months and provide validation, acceptance, and reassurance in ways that brought us all to tears?

Because he gave us what we yearn for. He gave us non-judgmental acceptance of our choices.

He gave us positive feedback.

He bolstered us to be able to keep moving forward with the same greatness with which we had arrived in the moment to watch his video. Why do we not get this validation from our jobs? Partners? Families? Friends? Some of us, probably do. Some of us have supportive and positive people surrounding us. But so many of us, clearly, are lacking in this area because it was painfully obvious we had not received any of this for a long time by our extra reactions to his video.

His voice was calming, unifying, and his message was of appreciation and hope. Hope. We all are craving the elusive ray of hope that crept out of his video. Are there other people who didn’t forget me? Do I really look great? Other people struggle with student loans too? He spoke directly to the viewer. It felt like sitting down with an old friend. He paused at the right time and the inflection in his voice was always to add calm not uncertainty. It was the least anxious two minute video I’ve ever seen. And if there is anything over the last 18 months it has been a steady influx of anxiety.

This is important because it shows what America lacks. Empathy, validation, and understanding from authority figures- employers, family, friends, etc. It’s important because it shouldn’t take one video to unravel us and that it did shows that we all need to be in therapy if we are not already because we are all raw, so raw. You cried because your emotions are bubbling so close to the surface it took one person to say- I see you. Your feelings are valid. I’ve felt them too. I see you.- to have you in tears. He did that therapy move that I do. He took a shot in the dark to say what we all needed to hear and he landed acutely on our weak spot in our defenses.

Why did we cry? Because we felt seen. Because we felt connected in a time of isolation. Because an old friend greeted us warmly without judgement and told us we are good enough as we are and that he is proud of us. It seems so simple yet we cannot find this validation, connections, and positive reinforcement in our every day life. We cried because we needed to cry; we needed a release valve.

I am grateful to Steve for his video. I am grateful it brought catharsis and relief to so many people. I am saddened that so much of America feels unseen. I can tell you as a healthcare provider and as a mental health provider for many other healthcare providers the most important unvalidated person walking America is the healthcare worker. We are tired. We are dying- from suicide, substance use, and damnit from COVID. We are sick of the horrific deaths. We are sick of the ignorance. We are burned out in a way that no one else outside of healthcare can even begin to comprehend. It’s making us resent the patients. It’s making ICU nurses refuse to turn their unconscious unvaccinated COVID vented patients, leading to more pressure ulcers, more black eyes from being prone and not having their cheeks turned. It’s making the fifteen respiratory therapists who can do ECMO in one hospital system think about quitting. All 15. If all 15 quit ECMO can’t function. I don’t think Americans grasp the devastating consequences COVID-19’s ongoing toll it taking on our healthcare workers. We are going to lose them all. There will be none left to care for us if we don’t get our shit together.

Get your shit together America. That moment that made you feel tears when Steve Burns breached your defenses…make healthcare workers feel that moment. Make them know that you see them. That you hear them. Get the freaking vaccine. Wear freaking masks. Stop saying science isn’t real. Because science doesn’t give a shit when you are drowning in the fluid in your unvaccinated lungs. Your going to die regardless.

This is a plea. One human to another. Think. Feel. Change. Because if you don’t we are looking at devastating consequences for our healthcare workers.

To my nurses I see you. I am you. I feel you. I understand if you leave. I truly do. I thank you from the bottom of my heart for the blood, sweat, tears you’ve already given. I can’t ask you to give more than you’ve given. We all hit our walls at different moments. If you’ve hit yours. Step away. Know it doesn’t make you less. I know you are not abandoning us. I know you have to take care of you in this moment and I will never fault you for that and if any one does- tune them out. They don’t know what we’ve seen and been through.

If you are still fighting the fight- rock on, stay strong, and take care of yourself in a way that no one else will. “You look great by the way. Whatever you’re doing. Keep doing it.”

#COVID-19 · Nursing

Therapist Friends

My sons started kindergarten. I have minimal pictures because I’m generally bad at taking pictures. I like to think it’s because I’m being present in the moment and just soaking up the emotion of it all. But it’s also because I forget. The first day the school and aftercare program lost them. They were never lost. They just didn’t get off the bus at the aftercare stop. So I thought they were lost. I had epic Mama bear panic ten minutes of tearing out of my office while picturing just pulling over every bus I pass and going up them aisle by aisle until I found them. But then the school secretary verified with Dattco the boys were still on the bus with a sleeping child who also missed their stop.

Nothing like a good adrenaline rush after a morning of blubbering for my week to start on the right foot.

The highlights I get from the boys are the bus rides, hot lunch, and yeah. That’s all they really talk about. I’m assuming there is some learning that occurs but who knows.

The great thing about being friends with therapists are moments. My friend and I were hiking in the woods. We had already dissected the boys being lost on the bus where I received validation that I was within my rights to have epic crazy town ten minutes.

There was a road within a half mile of where we were hiking. We just couldn’t seem to get there from the paths we kept choosing. There was a lovely orange circle that looked really easy and was 2.1 miles. Perfect. Then we were on blue. Then we were on blue/yellow. Then we were on orange/yellow. Then I don’t know how but we ended up in an unmarked section where another person emerged looking confused.

We kept walking. I was sweaty, hot, and cranky by this time. Meanwhile my friend who is a therapist says, “Maybe we are just supposed to be lost in the woods right now. Maybe this is exactly what we both need right now.” She literally says this smiling and if she could have been skipping I feel like she would have been. There I am the nurse. The nurse is like oh hell the fuck no fucking way are we supposed to be fucking lost and sweaty…and I’m not skipping. I keep that all inside though as I mentally handslap my forehead and look at her smiling positive attitude and try to channel the therapist side of me.

I gotta be honest. I couldn’t find it. But I did smile because how therapist-y was that moment? And literally. I just pictured her skipping.

(She sometimes reads my blog…I say this with love my friend)

I’m not sure the plus side of friends with nurses. We swear a lot. We are blunt. And you send us pictures of random skin conditions and expect diagnosis and treatment. Literally happened the same day from another friend and is not uncommon; not even a trigger warning usually just a random picture of a body part with a rash. (She never reads my blog but on the off chance: with love also my friend)

My therapist friends and I are careful to never do therapy on one another. And if some one starts to sound to therapist-y we will say, “Stop therapizing” at which point there will be denial they are therapizing but also a general backing off and trying to approach differently. The pro’s of therapist friends are we can get into deep analytical discussions that other people would find boring. They also say things when we are lost in the woods that are annoyingly positive but also hilarious because it’s beyond comprehension to me how some one can be that positively existential while hot sweaty and lost.

When I went into psychiatric nursing I never thought of a by product being a cache of therapist friends that would develop over time. But here we are. It’s been interesting evolving from emergency department co-workers to psychiatry. They are all a little messed up but in very diverse and special ways. I vibe with both sets. Definitely my people.

What’s nice is that I can be therapist-y and a nurse. Typical intake with a nurse goes something like this, “So you were a nurse?” “Yeah, but I’m still a nurse, I’m just an NP now.” “Yes but in psych.” “Yeah….okay. I worked in the pedi-ED”. “Aw shit. Okay so you’ve been in it.” “Yeah, you?” “ICU. (or ED. or MICU. etc.)” “Nice, you see other psych providers?” “yeah they don’t know shit.” “Yeah, it’s hard to describe what it’s like seeing some one’s insides or holding their brains in your hands.” “Yeah. I like you. I’m so glad I found you.”

Ver batim I’ve had that conversation more times than I can count. Nurse’s have seen some shit. It’s different sitting with a nurse as a provider than sitting with a therapist who has never worked as a nurse. I usually have to reference seeing guts and brains (which is not a lie or exaggeration) in order for them to relax and open up about what’s going on. Their reason for seeing me does not even have to be about nursing but them just knowing I get what they see relaxes them.

I’ve never regretted going into psychiatry. I’ve never regretted declining intakes to save spots for nurses and the LGBTQ community. I’ve never regretted forging the friendships I have with therapists, in fact they have seen me through some of the hardest couple years of my life starting back in 2019 with the death of my Dad.

I am a firm believer in fate and people showing up in your life when you need them. I worked in the ED when I needed ED friends. I still have them as friends, but not seeing each other every day like we did means we naturally grew apart. What’s nice about the ED though is I know I could reach out to any of them at any time for anything and they’d have my back. Just as so many have reached out to me for family members and friends since I went into psychiatry for help connecting to services.

I honestly feel blessed for the people who have been in my life since going into psychiatry. I’ve met such good people who work hard, are smart, compassionate, and are just good role models for me professionally and personally. And I’m still surrounded by nurses too; they are just psych nurses so haven’t necessarily held guts and brains- still cool but different than ED nurses.

I’ll take the annoying positivity while lost in the woods because that’s what I need. I need people who see the best in others, therapists seem far less cynical than nurses, because it’s something I need to practice. Since March 2020 mental health providers have been stretched beyond what you can even imagine.

I see it, I hear it, and I feel it.

We hold pain, secrets, love, and loss. I started my day today with a person calling and bursting into tears when I said we could not take her daughter as we are closed to adolescent referrals. Then I heard her story of calling fifteen offices and I was the first person who even answered the phone. Not even my client. That’s how the days go now though. Long, hard, and with a lot of tears.

I have such immense respect for mental health professionals, my friends included, because this work is hard and my friends in particular can still hold onto such positive outlooks in the face of such darkness. They also are woke and call themselves out on privilege. They make me a better person. I know my psych APRN friends right now are going, hmmm, am I a therapist friend or a nurse friend? More on the therapist friend side but with the cynicism of a nurse. Good people.

Take this for what you will. An ode to my friends- therapists and nurses- who helped me survive the last couple years. I can’t remember a time in my life I needed friends more and of course it was the hardest time to see anyone. I am grateful for the people who keep showing up for me and who I am happy to show up for.

This is also a call to examine the people you surround yourself with and what they contribute to your life. As I get older, as my kids get older, they see my friends. They know them. I surround myself with people I want my children to know. There should be equal parts giving and taking with one person perhaps taking more at different points in life and vice versa.

This is also a thank-you to all the mental health professionals still standing in the wake of COVID-19. I see you, and I thank you from the bottom of my heart for all you are and do.

And if you’re friends with a nurse…two words: Trigger. Warning.

#COVID-19 · homophobia · Mental Health Stigma Suicide · Nursing

Ten Things I’ve Learned as a Mental Health Provider During COVID-19

  1. People can only handle stress for just so long. When I explain chronic anxiety and depression to patients I often use the analogy of a teapot. When you are walking around filled up with stress/anxiety/trauma/depression for years eventually you do not have room for normal every day stressors. This leads to epic breakdowns over seemingly innocuous things. Did you ever cry when you couldn’t open a jar of sauce? Or start screaming when you can’t find your keys? We all have a boiling over point. February 2021, about eleven months in, seemed to be most peoples boiling point. In the Northeast we had a lot of snowstorms which I think compounded things for many of us. My practice received upwards of ten-fifteen calls a day just from new referrals, not counting our five hundred plus current patients who also all started to melt. These calls were desperate. Crying into voicemails. There were suicides in our communities. There were drug overdoses and relapses. February 2021 honestly was one of my hardest months as a mental health provider.
  2. Women bear the brunt of childcare and homeschooling responsibilities. This is a gross generalization. Please note I know that there are many wonderful Fathers and husbands who have supported their families during the pandemic in every way imaginable. But in my own practice I have seen my female clients taking responsibility for the organizing of homeschooling. They have described screaming matches with their partners about who has to sacrifice work time. I’ve had women clients leave their full time jobs, drop to part-time, and/or change positions in order to accommodate their children suddenly being home full or part time. I have seen women making sacrifices and publicly smiling but privately falling apart with grief, anger, and sadness.
  3. Minorities are under more minority stress. From the LGBTQ community to POC to children to the elderly. All vulnerable populations have been made more vulnerable. The death rates of COVID-19 are disproportionately higher in the African American communities. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-deaths.html Does a nice job of objectively presenting this evidence. The LGBTQ individuals who have lost jobs and been forced to move back in with homophobic and transphobic families are real. LGBTQ children, teenagers, and college aged individuals who have to live with homophobic and transphobic families is real. Suicide risk is high in this population already. The social isolation and inability to be “out” due to COVID-19 has added to these already significant issues for minorities. I literally have had telehealth sessions with a client crouched in a dark closet (and the irony of them being in a closet is not lost on us) in order to obtain privacy in order to cry in despair at not being able to be “out” and to have to experience homophobia and/or transphobia in every day life with their family. These sessions are gut-wrenching.
  4. Postpartum Moms and Dads have stress you can’t understand. I’ve often said the most unsolicited advice I ever received was during my pregnancy and in the first year of my twin boy’s lives. People who have been parents or not have opinions and stories and think everyone should hear them. Being postpartum regularly is hard. Being post partum during a pandemic when so little is known about the impact on newborn health is terrifying. Newborns can’t wear masks. Babies in daycares crawl and touch each other’s boogers. Parents have delayed putting their children in daycare because there is no true protection against exposure for infants. They are told that they are right, wrong, stupid, smart, and everything in between by people around them. I have never treated as many postpartum women as I have in the last year. SO much of it is providing reassurance that they are doing everything right. That there is no one right decision. That they know their baby and their lives best and they have to make the best decision for themselves. I offer validation and objectivity and I have seen them cry when I’ve told them they are doing everything right. Because no one has validated them since they gave birth. Unless you sit with people who have newborns day in and day out and see the agonizing choices they have to make; you don’t understand. And you shouldn’t be offering anything except validation and support.
  5. People NEED people. I’ve also said before I’m not a hugger. But the first time my friend and I hung out after we were both vaccinated and she asked if she could give me a hug and I enthusiastically consented. We weren’t big huggers before COVID-19 but after a year of isolation we unashamedly and laughingly embraced. One of the most poignant sessions in the last year, that has consistently stuck with me, was a young adult who lived alone and who did a Zoom with her family for Thanksgiving. Through tears she said, “I had to do a Zoom with my family. I just. want. to. hug. them.” Her breath hitched with each word and the tears turned to sobs and we sat for several minutes with her sobbing and me watching; neither of us speaking. I held back tears of my own as I wanted to reach through the screen and pat her shoulder and tell her it would all be okay. I heard so many of these stories but her vulnerable and raw pain in that moment touched my core. I had clients tell me their parents cried during their Zoom Christmas’ and they couldn’t stand to see their Mom cry. I sat with them through that pain. I offered nothing but space and understanding to feel pain. I have never known with such certainty after the holiday season of 2020 that we need physical touch to survive. We need our families. We need connection. Of all the long term sequelae that COVID caused, the isolation and desolation of being alone is by far the worst.
  6. Never underestimate the power of pets. I don’t have to explain much about this. If you have animals then you know what I am referencing. The isolation of this past year has made people get new pets and appreciate the ones they have. Pets are some of my clients purpose in getting out of bed every morning. They have truly saved lives this past year just by existing and offering unconditional love. To all our four legged friends, you have my true admiration and thanks.
  7. People who treated their mental illness before COVID faired better. One of my clients who was extremely ill a few years ago, but has since stabilized, greeted me smiling at our six month check in. She was doing great, and felt validated in her own experience of mental illness. “People know now how it feels to live with anxiety. I can now explain to people mental illness and they get it. Because their anxieties about COVID are exactly how I felt about everything all the time.” She wasn’t my only client who had severe mental illness in the past and stabilized with medication and therapy who have done excellent during the pandemic. They had coping skills, we knew what medications work for them, and they were connected to providers. My takeaway from them is to deal with your mental illness before you boil over.
  8. After people boil over Desperation sets in. I think it’s hard for some one to truly understand desperation until they have experienced it. Desperation is finding cuts on your childs arms or legs and bringing them to a hospital and being told they are not sick enough to be admitted and to connect to outpatient care, then calling forty providers and being told no one is accepting patients. Desperation is watching your loved one suffer and struggle and slip away and not be able to find them help. The mental health system’s flaws are fully exposed now. There are not enough providers. The providers that are in practice are un-paneling from insurance because insurers have made the last year so much worse than it needed to be for small practice owners. I have been screamed at on the phone more times than ever in my career when I call to tell people I am full or not accepting their insurance or not taking pediatric referrals. I have been threatened. I have been told through tears that they are desperate. I have been begged and pleaded with. I have been offered twice my normal rate just to fit some one in. I had to not return every phone call because I became fearful of what would be said to me when I told them I was not accepting patients. I had to hold my own boundaries and not take new patients in reaction to other people’s desperation. Because I was becoming burned out. I grew as a clinician and a business owner in the last year in more ways than I ever imagined. I also heard and saw desperation in ways I never imagined I would.
  9. I will always accept Medicaid. So many of my clients have been on and off Medicaid and commercial plans this year. Medicaid’s rates of reimbursement in my state are disgustingly low. But I will always have it as a plan I accept because my patients who lost commercial plans this year with job loss needed to have continuity with their mental health provider. I do not want my practice to be fully medicaid as that’s not sustainable revenue wise for a small practice. However, it will always make up a stream of our revenue because it has to be an option when clients lose jobs.
  10. Everyone has it bad. In the past year I’ve heard why the people in their 50’s and 60’s have it the worst. I have also heard why kids in high school, college, in their twenties, single people, married people, parents and non-parents all have it the worst. Every one thinks their lot is the worst. Young people are missing out on proms, college admission is being delayed in some cases, parents are overly burdened with childcare duties, single people are the most isolated, etc. I’m just throwing this out here; it’s been a shit year for everyone. There have been highs and lows for all ages all social statuses and in every way imaginable everyone has undergone stress, loss, and an understanding that things will never be like before. There is a before and there is a now and there will be an after but life will never be the same.

Through this past year of COVID-19 I have lived history. I am a front lines provider during a global pandemic. I have been through more personally and professionally than I could have imagined. My biggest and best takeaway from this past year though is to be grateful. I am grateful for my children. I am grateful for our health. I am grateful that I have been able to see my mom and sister, sister-in-law and niece, throughout the last year. I have known loss. I have grieved. I have cried. I have hoped.

About a month ago, I went to the office. I saw a long term therapy client for the first time in person for several months. He sat down, and I sat down. We both removed our masks. And we smiled. We were both vaccinated. The window was open. We sat eight feet apart. And then we had a therapy session in person without masks. It was possibly the most beautiful moment of the last twelve months.

#COVID-19 · Mental Health Stigma Suicide · Nursing

When I’m Called Out by Clients for Swearing, Caring, and Everything Else…With Love. A Day in The Life of a Mental Health Nurse.

An unexpected perk to having a therapist on staff full time with us is hearing from her what my patients think of me. I have referred more than a few of my clients to her though some of them I’ve seen for over three years for medication management and for one reason or another they needed a therapist at this time. Apparently the impressions are hilarious.

Occasionally my clients will directly throw my words back at me. Recently a young adult attending college in state needed to see me urgently. After we processed the current crisis and made decisions about medication I smiled and said, “Isn’t this great that your in state and we can do telehealth?” The client laughed and said, “Well I recall you saying if I went to school in Iowa, one of my top choices, that I’d be in ‘East bum fuck middle of fucking nowhere and there’s no way in hell I’m managing your meds out there'” I have a chagrinned smirk including blushing cheeks that emerge when properly embarrassed and I replied, “Yes well, that does sound like something I’d say…” We were both able to laugh. Now I know that client didn’t go to school in Iowa for a few reasons, including COVID, not just because I wouldn’t manage their meds in east bum fuck nowhere. But it is a humbling reminder to know that I do play into people’s major life decisions.

One of my clients did an imitation of me to the therapist at my practice…who texted me while laughing to tears because it was incredibly accurate and I am funny without meaning to be which usually makes it funnier. The impression was from our intake. Our intake was over three years ago. I was very direct. I warn people I’m direct. I don’t think any one really believes me until they experience it. And again, I was humbled. Because these moments in time are so important to clients. They stick in their brains these intermittent appointments with me. Words are so powerful. Body language. Facial expressions. This client nailed it all.

What I learn over and over is that my clients are paying attention. That I have an hour intake and thirty minute follow-ups maybe once every three or six months if they are stable and those minutes are precious. I try and respect them. I swear a lot. That’s not going to change. But apparently between the swears, the sarcasm, the checking in, I impart an energy and words that stick with people. It’s a privilege to be that person. We in mental health should never take it for granted.

I have a client I have been seeing for a few years, and the parents brought up at our last appointment, “Hey do you remember when you made us leave the room because you had to have a ‘Come to Jesus’ moment with them?” The Dad was cracking up. He said, “We didn’t know if we would see our kid again! But we knew then we were in the right place.” I did that embarrassed smirk as I thought back a couple years, and in fact I did remember telling the parents to leave. I didn’t raise my voice. I got down at the kid’s level though and told them to take their ear buds out when I ask them to take them out. To respect my fucking time because I’ve shown them nothing but respect even when they are acting like a little entitled punk. I may also have told them to undo their wedgie and let’s start again.

Sometimes I remember those moments and do a facepalm. I obviously do not speak to all people this way. It’s my job to read people. I’m good at it. I know who it’s going to be effective for and who it won’t be. And that kid never wore the ear buds again, and honestly has been very respectful to this day in our appointments.

Recently a parent asked me if I thought their educational plan for their child was “crazy”. I didn’t hesitate when I responded nodding, “Yes. I do.” I remember the parent looked at me and laughed a little and said, “Well you’re the first one who’s at least been honest with me.”

Honesty can be a bitter pill for people to swallow. It’s definitely not for everyone. Again, I give myself a disclaimer up front to any prospective clients. “I’m direct. I will call you out. I encourage you to call me out too if there’s anything that needs to be addressed.” But it can open doors to take your head out of the sand. My honest response to that parent opened up an entire conversation about their own self doubts and their strengths and weaknesses as a parent. It allowed a space for them to be vulnerable that wouldn’t have been there if I had just smiled and said “No of course not,”.

I’ve also learned that as long as I’m honest without being judgmental…which is a hard skill to master…it goes over a lot smoother. My clients that I take time to build rapport with and I really get to know and who get to know me, they know when I give them direct feedback it’s not from a place of judgement. It’s from a place of genuine curiosity and caring. I want to know if I’m on target with my assessment. I want to know if they know I’m on target or not. I want them to think and feel things that they haven’t let themselves think and feel. I want them ultimately to get better.

I was asked recently by someone how I felt about “…profiting off the pain and sorrow of others. I mean people have to be suffering in order for you to get work right?!” This was not a friend. And was said with some malice toward mental health professionals. I responded that I think about that a lot. And that should there come a day when my services are no longer needed I will feel such immense joy that it actually brings tears to my eyes to think of that day existing.

I remember resisting the impulse to defend all that I do; all that I give to my work. It doesn’t feel like a profit when a client is hospitalized for suicidal ideation. It doesn’t feel like profit when I end a day sitting on my floor wiping away tears because of all the emotional trauma I’ve held space for in the last eight hours…trying to pull myself together in the five minutes I have before my sons bounce through the door. It doesn’t feel like a success to educate my client about their diagnosis of schizoaffective disorder- how it’s lifelong and they will have more episodes of psychosis and we need to plan for when not if.

Those are all the moments that stick with me. So it’s nice to hear from clients who remember other moments. Who remember me swearing with love. Who remember the limits I set with fond affection and admiration. Some of my clients have done impressions in front of me and they are pretty good. I should be a meme.

Clients send me videos of their engagements. Wedding pictures. Newborn baby pics. Those hilarious therapist memes. Some one sent me a Christmas card thanking me for all my help and crediting me with helping them be healthy enough to become a Mom. I cried hardcore when I opened that one. I am allowed into these intimate moments in people’s lives because I know more than anyone the emotional labor they have put in to get to these crucial turning points in life.

The positive feedback is few and far between for healthcare providers, especially mental healthcare providers, but it’s there. Even the impressions. They crack me up. This year more than any I needed the positive feedback. I am beyond grateful for it.

To consumers of the mental health system- I thank you. For trusting me with your mental health. For seeing me for who I am even in moments of tough love. To families of consumers- I thank you. You have trusted me with your most precious cargo. I don’t accept that responsibility lightly. To the therapists who have to endure impressions of me- Enjoy. I’m pretty freaking funny especially when I’m not trying to be and yes. I swear that much.

#COVID-19 · Mental Health Stigma Suicide · Nursing

You Don’t Know Me At All. Me: to every hospital I’ve worked for.

I recently received a heavy metal coin in the mail from the hospital I work at per diem. It was accompanied by a trifold letter thanking me for my hard work during the pandemic and ended with a “we are all in this together” statement. It explained the coin too. Likening it to soldiers being honored with metal coins for acts of bravery.

I didn’t work much at the hospital this past year. I had enough to keep me busy with my practice. I also felt that the hospital left a lot to be desired in terms of infection control measures in the psychiatric hospital. I felt safer working remotely at my practice.

But there were many essential frontline workers working day and night caring for COVID patients. Caring for NICU patients during a pandemic. Caring for maternity patients who had to give birth alone wearing a mask after their partners tested positive.

I opened and read the generic letter, held the coin, and though of the scene in the Office when the CEO of the company, Robert California, looks at the regional manager Andy and says, “Sometimes I think you don’t know me at all,”

If you’ve seen The Office you know it’s satirical. It’s a commentary on how every one lower on the totem pole from management feels that management doesn’t actually know them at all.

I felt this viscerally holding that coin. I felt affirmed with every atom of my being with my decision to leave hospital and agency work full time and venture into the risky world of self employment via private practice. The few times I’ve worked at the hospital I thought I would have lost it if I was working there full time this past year. And the nurses and doctors and respiratory therapists working there full time for the past year deserve more than a worthless coin and generic thank-you letter.

I’m going to give the example of how I treat my employees. Because I’m a big bad boss now. My employees received everything necessary to do telehealth at home. Headphones. Lifted desks. Second monitors. Printers. Scanners. Anything they needed I got them. I screen all their calls and messages and deal with whatever I can on my own without bothering them. If they ask me to intervene and discharge some one I do it. No questions asked. Because I trust their judgement. For Christmas I gave my part time employee a bonus. I gave my full time employee the option of a cash bonus or tax exempt options like insurance premium, HSA contribution, student loan payment, etc.

I ask for their input on what charity to give to locally whenever I make a donation through the business.

I give them positive feedback whenever I get it from clinicians and patients. I pay them an extra hour a week if I know it was heavy on administrative time outside of client time. I say thank-you whenever I ask them to do something and they do it. I have never bought them pizza. I have bought them sushi and nice chocolate and wine and beer. I’ve given gift cards to restaurants and Amazon for nurses week.

One of my friends who is an APRN asked how much money I make from my employees. I told her I don’t make much because I didn’t take on employees to profit from them. I took them on because I wanted other prescribers to practice with me. And when I decided to take on employees I made a conscious decision to never treat them the way I had been treated by my employers and managers in hospital systems and private practice. I want my time that I spend doing their billing and scheduling and call backs to be covered. But aside from that I’d rather invest leftover money back into my business and subsequently back into my employees. Because I know what it feels like to work myself to the bone. Giving literal blood, sweat, and tears to a system that rewards you with pizza and a coin.

My fourth full time employee came on recently and took time to decide to increase to full time. The reason she gave for doing so was because she knew that the first two employees both started at less hours and both have continuously increased their hours in the past three years, one to full time and one to part time. She said that spoke to the business in terms of retention and in terms of them continuing to give more to the business. That moment felt good.

I despise how hospital systems cry poor. All the time. I didn’t get consistent raises my first eight years as a nurse. I felt powerless to fight for them. The systems were designed for us to fail to get increases. These are billion dollar organizations. Not million. Billion. Tell me they can’t give their employees something bigger. Why not cancel all current medical bills being held by their employees? Why not cover their health insurance premiums fully for at least a month? Why not provide free or discounted care for their employees? Why not pay 1000.00 toward every one’s student loans? Why not skip their CEO’s bonuses and give it back to their staff? Why not invest in their front lines essential heroic workers?

Freaking coin.

On the other end are burned out healthcare workers who think they don’t or can’t have better or more.

You can. You just have to work for it and you have to be willing to take risks.

Before the coin. Back before the pandemic back in 2017 when I opened my own practice. I put a 2$ fake paper bill from my hospital system on my wall. It’s still there. Taped over my desk. I treat employees of the system who recognize it and always ask why I have one of them taped on the wall. I encourage them to read the message on it. They lean in and then understanding dawns and they inhale sharply. Then they turn to me in disbelief. I nod. “Thanks for saving the life of a patient.” They always say it out loud. Like they are reading it wrong.

I nod again. “But I mean like you actually saved some one or it was just a close call?” they stammer trying to disbelieve it still.

“The patient was blue. I cleared her airway. I was told by multiple people there that day and after the patient would have died if I was not there.” Then they always nod their head and shrug their shoulders in resignation, “I believe it. 2 bucks. And a fake 2 bucks. That’s all we are worth around there.”

The two fake bucks that can only be used at the cafeteria of that particular system was not the first nor the last time I was let down by an employer in healthcare. But it was the first time I remember feeling resolute in my decision to get the hell out of there. I knew I needed to be somewhere that valued a patient life and my ability to save it. The coin six years later affirmed that decision.

To all my healthcare provider friends reading this. I see you. I know what you give every day. I know what it takes away from you. I’m sorry you are not valued more. But know that you are valued by me. I see you. You are not alone. You deserve more. If you are reading this and you have any say or control over how employees healthcare systems are treated: do better.

If you or someone you know is struggling with suicidal thoughts please call:

1-800-273-8255

#COVID-19 · Nursing

Hope in 2021 & Yoga

I recall saying that 2021 could be worse. Several times. When I said that I have to be honest I was not picturing an insurrection against the capitol caused by #45. But I knew it could be worse.

I don’t have a lot of coherent thoughts about that week because when I think about it I feel this gut wrenching burning anger and fear and a lot of other feelings too. Probably shame too that this was my country. I think about my Dad, turning over in his grave; he would have been the first to volunteer for the National Guard to go protect the Capitol. He would have been furious. I can almost hear him ranting.

It’s hard to put into words what it was like watching the footage of that. So I won’t. Because nothing I say can do it justice.

Sunday my sons were with their other Mom and my sister-in-law was teaching a yoga class. Live. In person. I agreed to go and it wasn’t until I felt my eyes welling up in Lizard pose that I realized why. I hadn’t done a live class since March 2020. So much has changed. So many lives lost. So much upheavel and isolation.

I never appreciated yoga classes until I didn’t have them. I do them on Zoom but it’s different. Dissonance.

I practiced next to my sister. I didn’t know any one else there. It was a huge cold industrial building converted into a gym space. Big enough that we were more than ten feet from any one else. We all kept our masks on the whole time and the ceilings were ridiculously high. It felt as safe as it was going to be in these times.

I had the benefit of being a week out from my second COVID vaccine. So I was less worried than I would have been otherwise.

I was there in lizard pose, with my left foot up next to my left arm. My arms on the floor. Head bowed. I could hear people as we moved through poses. I didn’t have my kids climbing on me or my cats scratching at my mat.

The most visceral aspect that 2020 lacked is connection. We lost our connections with other people. With our humanity. It felt reparative; that moment in Lizard. I was cold. The floor was cold. It was twenty degrees outside. I’m used to hot yoga. This was the opposite.

I had on three layers at one point and my socks.

The acoustics were bad and I could barely hear my sister-in-law as she called the poses.

But that five second moment in Lizard I thought that this was one of the most blissful moments I’d had since March 2020. It was a moment of connection in a time of isolation. It was a moment of light in such dark times. And it gave me hope that we would survive this and things like yoga classes will happen again.

This week I registered with the hospital I work at per diem to administer COVID vaccines as part of their mass vaccination movement that starts this week. Not only do I get to stick people with needles, which after almost a year of telehealth, brings tears of happiness to my eyes, but I get to see other people. Talk to other people. I get to nurse people. In person.

Yes I’ll be masked, face shielded, and jabbing people with a vaccine that has more controversy than any vaccine I’ve encountered in my life. But as a nurse I can’t decline being part of this movement. That line from Hamilton rings, “History has it’s eyes on you,” and I feel super corny saying it but it feels like I’m part of history. Some day when I’m super old and a general annoyance to my children and grandchildren I’ll tell them about COVID and life during a pandemic and how I vaccinated people against it.

I’m sure they will be bored to tears and likely try and escape my presence as soon as possible…and maybe I’ll pretend I can’t hear or like every other old person I’ll pretend I don’t notice the social cues that they are bored and plod on in a boring account of administering injections.

It’s a weird time. A new administration. Fox News doesn’t talk about Trump much these days, or the Capitol insurrection. So that’s cool:/ Yes I check Fox News. I like to know what my fellow Americans are being told so I can counter it. I used to think life would go back to normal after COVID. Now I know there is no normal. There is a before, a now, and a then. The before is gone. The now is here and then is coming. None of it the same as before.

Even my beloved yoga has changed. I can get further into half split then ever before. I can do a one legged stand almost perfectly. I’ve spent the last year continuing to deepen my practice. So when I hit the mat in an actual in person live class it wasn’t the same me as before COVID. But it still felt damn good.

Nursing

Nurse to Nurse. Hang in There.

I have been walking around with a ball of anxiety in my stomach for roughly two weeks. I knew last Friday would be a turning point. When I left my office that night I packed extra things I normally would leave there. I stopped going to hot yoga two weeks ago.

You know that was hard for me. But I knew from the stories coming out of Italy that after even only a handful of cases in our state the worst was yet to come.

I did a presentation once on mass casualties. The head of emergency response of our state was there. I presented on Hurricane Katrina. The largest barrier for them was helicopters. They didn’t have enough helicopters to rescue people, and they waited roughly 5-7 days to contract with private companies. By then many had died.

I asked the head of operations how many helicopters we have in our state. He said, “One”. You could hear a pin drop. He rushed to add that we “would never see flooding like in New Orleans,” to the roomful of 100+ people now freaking out that we were all going to die.

Two weeks ago I started to get a pit in my stomach because I am acutely aware of the estimated number of ventilators in our state. That was part of my presentation five years ago. I was also acutely aware that the numbers coming out of Italy were bad. Very bad. I started feeling like we were New Orleans being hit by Katrina with one helicopter.

A lot of people are going to die. We are going to be faced with tough decisions. I implored my Mom to stop yoga class and any other outings. I bought into social distancing far sooner than the rest of our country because being in healthcare is a double edged sword. We know the limitations of our system. We know how to interpret statistics and death rates and percentages. I knew two weeks ago we don’t have enough ventilators to save people in a pandemic.

I moved my practice to telehealth only. Of course so did the rest of the USA so it’s been a nightmare dealing with insurance companies. Many patients are still canceling though because they don’t have their own incomes and are worried about medical bills, even small co-pays can be detrimental when people are out of work.

In the midst of me worrying about keeping my practice afloat I received messages from the hospital I work at asking for me to work there in the coming weeks. I know the risks. I also know all the people who work there have their own risks.

I know the doctors with kids with cystic fibrosis, the doctors over 60 with cardiac disease, the nurses with respiratory diseases, the social workers…I know everyone’s story just like they know mine. I know they are risking their health and their families every time they go to work. It’s not a question for me. I have to help out. I didn’t go into nursing thinking there wouldn’t be any hard times.

None of us make enough money for the work we do. But we all take these risks to take care of strangers not just for the strangers, our patients, but for each other. The bonds of health care professionals are what keep us all going. Time and time again when I worked in the emergency department I didn’t show up for management or the money. I showed up for my co-workers. The same is true now.

I know how it feels to be short staffed. I know how it feels to be scared of going to work. I’m scared to go to work. But I’m going to go.

To all my nurses and doc’s and techs and hospital staff- hang in there. You are the true heroes in our society. You deserve the tests that the NBA team received. The disparity in our society that we laud celebrity and neglect our most valuable members of society- nurses and healthcare professionals- is despicable.

I know we are afraid. I know we don’t have enough supplies. I know we are all putting ourselves and our families at risk. From the bottom of my heart I thank you for all you do and I’m with you. I’m showing up at work. I’ll see you there. Tune out the noise and do what we do best. Heal. Tell dirty jokes. Make horrible coffee. Complain about management. And save some lives. We got this.