So here’s to a beginning. I have been wanting to write for a while but haven’t been able to pull together the words as to all that I have been feeling and learning. It has been on my heart to share some of my experiences that have truly shaped me to be the person I am. It has pressed on me to share about some of my darkest times and how I was carried through. This blog is dedicated to the Lord, the very one who carries my world.

Monday, July 10, 2017

Diverging Emotions

I briskly cracked the driver’s side window open as I peeled out of the driveway on a chilly winter night. As the cool night air invaded my space I began to feel less suffocated, my thoughts less stifled. Driving had always been my sacred place to think. But things were feeling hazy now. And I couldn’t seem to reconcile my diverging emotions. For what felt like an unending lapse in time, my heart simultaneously believed it had achieved what I had been dreaming about since I was a little girl while also regrettably feeling more void and empty than I had yet experienced. It seemed the more successful I became in terms of my career, the more brightly shone the glaring light of truth that haunted the deepest part of me: I was alone.
My final semester was well underway, and I wasn’t sure where I would go from here. I had always found comfort in school. Set schedules. Lectures. Even exams. I liked knowing I could (if I really worked at it) succeed (for the most part- with the exception of a stingy or stubborn old professor here or there). But you get my point. Part of me was filled with wonder in postulating what my first job as a nurse practitioner would look like, curious if that would somehow bring the fulfillment I had been craving. I was intimidated and excited about the road ahead. Even still, there was an aching. I tried my best to cover it up. I knew well how to put on a good face. But something in me hurt. And it oddly was not alleviated by proximity to others. At times, the company of others served to only exacerbate my pain, further reminding me that after all these years I was still alone.

It followed me around as I watched friend after friend go on to become engaged and married. Was I being punished for my prior mistakes? In my heart of hearts I knew that was not the God knew, but I also knew I was no longer a nineteen-year-old girl. Time was passing, and I was starting to get nervous. Was this just not in the cards for me? Was I meant to remain single forever? I shuddered at the idea.
More, my frustration grew as my interactions with the few guys my age that did attend the church I was attending were nothing short of boring and/or rude. I certainly had not been used to that in past years. Why would God bring me here of all places?

As months passed, I began to feel more distant from the friends I had made. Something in me related less, and I couldn’t understand why. I began to feel older, more mature in some way I couldn’t put my finger on. Maybe it was that I had finally come to realize I had always been older, given the events of my past. Maybe it was just time to move on.

A quiet confusion rested on my heart as I struggled to chime in to the worship service the following Thursday evening. I had always loved Thursday night services. They were typically packed, and the worship was boisterous and exuberant. But tonight felt different. As I glanced around the room I couldn’t help but feel like somehow things had changed. And I couldn’t understand why. For the first time since I had first walked through those front doors, I began to feel like I didn’t belong.
Where was I supposed to go from here? This was supposed to be my family. I figured I would probably grow old going to this church. How could this be happening? And what was God doing? I felt in that moment I understood absolutely nothing about the way God works. Having known him since I was a young girl, he felt like a stranger. What was he doing?
I knew I could leave the church altogether. I knew I could leave my faith at the door and just get in the car and go and never look back. A few months prior I had been contacted seemingly out of the blue in the same week by two ex-boyfriends looking to rekindle relationships. It was too big of a coincidence to brush off. But the thing of it was, I hadn’t gone on a date in over a year. And during that time God had healed a lot of my brokenness. And more than that, I had remembered who I was. I was a child of God. And I was loved. And I just wasn’t willing to give that up for anything. Including the company of some guy.
I did tell each of them to come to church if they really wanted to know me and what I was about. Neither ever showed which surprisingly brought great relief and even more healing. God had made it clear that they were not for me. Not one bit. All I needed to do was trust him.
And boy, I’m glad I did.

Friday, June 23, 2017

Not So Black and White

Before I knew it, I was waist deep in notecards and PowerPoint slides for health assessment, nursing research and pharmacology. One day per week was spent on campus attending lectures. It was a full day with little time for breaks. As much I enjoyed my schooling (and truly, I did), I found by the end of each Tuesday, my legs, involuntarily and ever so wildly, bobbed through the last ninety minutes of lecture- a likely consequence of having consumed three cups of coffee, knowing full well my body was done a long time ago. But a girl had to do what a girl had to do to get through.
Two full days per week were still spent at the hospital working as a nurse. I had been on my own in an apartment for some time, and I wasn’t willing to move back home just to complete school if I didn’t truly need to. More, I knew my experiences at the hospital would certainly enrich my growing knowledge base. It also didn’t hurt being in close proximity to those whose careers mimicked exactly what I had been striving toward. And I made certain to capitalize on such opportunities with many seemingly spontaneous (yet previously considered) questions about various roles in the profession.
Two additional days per week were spent at various clinical locations, oddly left to our own choosing and our own finding. The idea of trying different specialties on for size was invigorating. I was getting closer to actually living out what I had been dreaming of for so long. And now I could taste it.
Even still, a smart part of me couldn’t help but acknowledge the nagging thoughts that had been smoldering below the surface. I half wondered if this was all going to be too much. Full time graduate school and part time nursing. I secretly wondered if the deck of cards I had been building was going to come crashing down on me at any given moment. I didn’t know if I could do it. I wasn’t sure it would all work. After all, my body hadn’t tolerated working full time as a nurse. And truly, it was all I could do to work the hours I had been assigned. Now, to add on full time schooling. I couldn’t be sure.
But I also knew there was only one way to find out.
I began my rotations in a primary care setting, an area of particular interest, where I cared for patients with a variety of health concerns, young and old alike. As a novice, I was comforted by the idea that a challenging patient would often be referred on to a specialist. There wasn’t pressure to be the ‘know all be all’ for any given patient. Or so I thought. More, I liked the idea of building rapport with patients and being afforded the opportunity to cultivate deeper relationships over time.
I knew I would never be the practitioner to run head first into a burning building. I wasn’t leading the charge when a patient coded, nor was I the first to straddle a patient to perform lifesaving CPR. I did, however, know when to get help and when to ask for it; and I wasn’t too prideful to do so. Emergency medicine was not in the cards for me, and I was okay with that. As a nurse, I had always found emergent situations to be somewhat draining and rattling, and the last thing I needed was some external stressor to trigger a flare.
And so, I eagerly focused my efforts toward outpatient medicine. I spent my first rotation working with a young primary care physician with short brown hair and worn brown dress shoes. He wore a white coat and a warm smile. His patients liked him, and I could see why. Eager to teach as we went through the day, I found myself vigorously jotting down notes between cases, knowing I was gaining precious knowledge that I wouldn’t have otherwise extrapolated from my textbooks. Some things were just better learned in person. A lot of things actually.
My second rotation was also in a primary care setting with a physician who happened to be very aware of his appearance, frequently discussing his food intake as well as salsa dancing after work. Patient interactions felt rushed and insincere as we raced through the day, seeing upwards of forty patients per day (nearly double what I had seen in my prior rotation). I was afforded little time for questions but was instead handed several medical books to read and memorize. My workload had already reached a staggering level, and it frustrated me that he would add to that. The volume of knowledge we were expected to learn and retain was bordering ridiculous. Doctors had four years to learn what we were expected to crank out in two! Nonetheless, I sat in the back room of his office, book in hand, feebly wondering where I would fall as things shook out over the next few years.
My rotations continued. Gynecology, orthopedics and gastroenterology. As time passed I came to see the primary care glove was not the perfect fit to my hand as I had once imagined. Instead, I found myself drawn to specialty medicine, namely gastroenterology. I was intrigued by the diversity of the field in caring for everything from autoimmune conditions to gallbladder and pancreatic diseases to irritable bowel syndrome to the screening and discovery of various forms of cancer. More, I had seen and cared for a good number of GI patients on the infectious disease unit at the hospital as a nurse. Somehow, it seemed to be an area of medicine that just made sense to me. I knew I would require much on the job training, as I had been in an adult medicine program geared at nurse practitioners working in the field of primary care. More, I hadn’t attended a GI fellowship like that of my physician colleagues. Even still, something in me was up for the challenge.
A few months passed, and before I knew it my clinical rotations were drawing to a close. I couldn’t help but pause for a moment, noting there was far more gray to the medical field than I had originally anticipated. Sure, certain things would always be black and white. A hematocrit of eight would always mean anemia, and a platelet count of 75,000 would always signify thrombocytopenia (low platelets). But there seemed to be quite a bit of gray in the profession as well. This gray area transcended personality types and social skills. It included big things like decision making. There were nuances. Moments of judgment requiring critical thinking, often left to the discretion of the provider based on a given patient’s particular case. I had come to see firsthand that lines weren’t always clearly etched which was both riveting and terrifying.
See, I was always more of a rules girl. I excelled in boundaries. I liked clear-cut solutions and believed hard work should always pay off. “A” plus “B” should always equal “C” and never “D”, “E” or “Z”. But, it turns out, like many things in life, medicine just wasn’t always so black and white.
Black and white, it seems, had been the goggles I had unknowingly worn for as long as I could remember. It was how I saw my profession and even more, it was how I saw my life. This lens of cause and effect was how I, at times (too many times if we’re being honest), judgmentally viewed my friends and family. More, it was how I viewed my faith. It was why I anguished over my rejection from medical school. All the pieces fit, or so I had thought. Why wouldn’t God help me so that I could help him? I was going to be a medical missionary after all. I had been a good Christian, why wouldn’t God make me healthy? Why wouldn’t he make my father healthy? I had turned my life back to him, why wouldn’t God bring a man into my life?
But it wasn’t about me. A lesson I fear I needed on repeat for many years to come. I had much to learn regarding the sovereignty of God. Regarding his power. Regarding grace. And love.
These dreadful short-sighted goggles it turns out, revealed only what was directly in front of me, completely handicapping my vision of God and what he was doing unknowingly all around me.
Maybe, just maybe, it was time to take the goggles off. Maybe it was time to see through a different lens.
Sure seemed scary to me. And with the changes occurring in grad school coming to a close and things at church feeling less settled, I found myself clinging harder than ever to my frail illusion of control. And so I stubbornly duct- taped those bent goggles of mine and adorned them as I had so many times before.
It was going to be a while before I would come to understand what it meant to really see.
And really live free.

Monday, April 3, 2017

Director of the Fear Parade

Days soon turned into weeks, and weeks into months. My career in nursing was well on its way. But it seemed there was a growing restlessness within me that I couldn’t escape. As much as I tried, I couldn’t deny the emerging dissatisfaction I felt. I had hoped starting over at a new hospital would eradicate any and all prior discontentment. But that wasn’t the case. I found myself listlessly watching the physicians in white coats come and go throughout my shifts. Watching. Wondering what could have been. Frustration rose and fell over me, knowing I was denied a chance they received.

More, why did so many find great meaning inside these walls and yet all I found was monotony? Routine. Time clocks. Rules. Supervisors. It all felt so empty. Restricted. Unchallenging even. Most days I found I blew through my tasks in record time while others struggled to complete all necessary tasks by shift end.
I couldn’t help but wonder, “Was there more”?
The road ahead was hazy with clouds, and there were no clear signs pointing which way to go. More, I still carried scars from the roadblocks I had once encountered. Jaded and unsteady, I knew the God I thought I had once known so well was in fact far different than I had once believed. A part of me wasn’t too sure I was ready to trust him again. Really trust him. After all, I had seen some things. Some dark things. And I had experienced rejection on more than one occasion.
But where did that leave me now? Where was I to go from here?  
I couldn’t be sure.
Without much in the way of assurance or even confirmation, I began my application for nurse practitioner school. I had studied carefully the differences between that of an advanced practice registered nurse (APRN) and that of a physician assistant (PA). I found myself interviewing those I worked with, any and all who would engage. I craved data. I sought personal stories told by those who had gone before me. It was exciting really, considering the possibility of working in a more autonomous role. The ability to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments including the prescribing of medications was thrilling to me. An inward stirring had begun again, and it was exhilarating.
I leaned up against the old wooden counter in the charting area one rainy afternoon. I had been talking with a PA who worked in gastroenterology, inquiring about what diagnoses she typically treats.  As she shared, I secretly pictured myself as one of the white coats.  
Would I someday round on these halls?
As I reviewed potential programs, I found the schooling to become a nurse practitioner far more doable, as I could continue working as a registered nurse while I attended school. A PA program would entail a full-time commitment. I knew the PA model would be more empirically based, leaning heavily on the sciences which was initially more attractive to me. But I came to learn that nurse practitioners were in great demand and practicing without supervision or even collaboration with physician colleagues in some states.  
And with that, I submitted my application for nurse practitioner school. I couldn’t be sure I wouldn’t again be faced with more thin envelopes, so I half braced myself for impending rejection. I could no longer rely on my once held ideals that God would help get me in. He had closed the door for medical school, and I knew he could just as easily close another.
But I secretly hoped he wouldn’t.
A week later I stood outside the hospital entrance. It was a warm day, late in spring. Bees were buzzing in the distance, and my eyes soaked in the vibrant hues from a nearby garden. People appeared to be walking in all directions around me, having emerged with nature out of hibernation. The sun gently warmed my arms as I began to make my way towards the door. I hated that I needed to go in. “Just a few moments longer,” I thought.
Looking to stall for just one more moment before the start of my shift, I pulled out my phone only to note an email.
It was from Quinnipiac University.
As I stood there in my turquoise scrubs and blue sneakers, my heart began to beat a little faster.
I had not expected a reply so soon. I had applied not seven days ago. This couldn’t be good.
I cautiously braced myself for what was to come as I opened the email only to find the relieving words, “Congratulations”.
I had been accepted.
The warm spring air swept through my blonde hair, and in that hope filled moment spring had been infused not only into the air but also into my soul. I swallowed hard as I reread those words over and over, waiting for my heart to catch up with my mind. Thoughts flooded my mind as I glanced up at the large hospital building. I was going to get my chance after all. I was going to be able to practice medicine as I had dreamed so long ago.
I couldn’t believe it.
It felt like I had ‘made it’.
And I couldn’t help but wonder if this had been the plan all along? Every painful delay. Every rejection. Even, dare I say, my sickness too? I wasn’t sure I was ready to acknowledge these truths, fully embracing my brokenness as part of his plan for good  
Ann Voskamp says, “It takes courage to listen with our whole heart to the tick of God’s timing rather than march to the loud beat of our fears.”
I knew I had been leading that marching band for as long as I could remember. In fact, I was an honorary director.
Isaiah 58:11 says, “The Lord will guide you always; he will satisfy your needs in a sun-scorched land and will strengthen you frame. You will be like a well-watered garden, like a spring whose waters never fail.”
He had been guiding me. All along. Even in what felt like the dark.
The clouds were clearing, and it was as if I could see my way again. But why had I been so reluctant to trust him in the haze? Was God only trustable when he did as I saw fit? When he obeyed all of my wishes?
2 Peter 3:9 says, “The Lord is not slow to fulfill his promise as some count slowness, but is patient toward you”. [Emphasis added]
Psalm 103:8 says, “The Lord is merciful and gracious, slow to anger and abounding in steadfast love.”
Not only does he fulfill his promises, not only does he guide us always, but he is patient with our stubborn and slow to learn selves too. And this patience was a life-giving gentle glory that had only just begun to soften my hard and all too self-centered heart.

Tuesday, March 14, 2017

HIV and a Terrible Mistake

Before I knew it, months had passed. Once cautiously guarded, I found myself begin to slowly relax into my role on the unit. I had some experience behind me now, having seen some things. Some things I will likely always remember. It’s amazing how patients come and stay for only a few days. And yet, their stories somehow live on in the minds of their caretakers long after they are gone.
The woman with advanced multiple sclerosis who could no longer move her arms and legs had a husband that came to see her and sit beside her three times per day.  He didn’t say much as he gazed at his bride covered in tubes and lines. Maybe it was because he knew she could no longer respond. Or maybe there just weren’t words to be said. But there was love there. And it was palpable and tragic all in the same beat.
The woman who had unknowingly contracted HIV from her husband who went on to develop AIDS and later AIDS dementia. She was grossly underweight and almost always requiring restraints of some kind due agitated behavior including but not limited to biting, hitting and scratching. She was surprisingly scrappy for such a small woman. I watched as staff members held her down to administer Haldol. The needle poked her emaciated arm, and I couldn’t help but feel like none of this was her fault. Her eyes were big and round and told the story of a life still fighting.
The woman who had been on respiratory precautions for possible tuberculosis. She had a bad attitude and made it clear very early on that she only wanted to be left alone. An hour passed, and a visitor came and left. I went to check on her only to find her locked in the bathroom. I knocked on the door, and she angrily told me to go away. I told her she needed to come out. As she made her way out, she began asking me about myself and my life. Had she had a sudden change of heart? Moments later I returned only to find her draped over her bed with a puddle of blood under her head, her body lifeless and purple gray. I called a code and CPR was started. But it was to no avail. We were to later find a syringe and a spoon tucked away under her clothes. She had been cooking heroine in the bathroom.
Each patient, it seemed, left an imprint of some kind on those hospital walls. The stories those walls could tell! And even more, indelible marks were being inscribed on the hearts and lives of those who looked after each patient.
Today would be no different.
I pulled the meds as I had so many times before from the med drawer and placed them next to my list of patients. I exhaled, pacing myself for the next four hours. We were short a nurse, and I had volunteered to cover. I wasn’t exactly known for coming in on my days off, but I knew they were desperate. “How bad could a four-hour shift be?” I thought to myself. I was relieved to see my list of patients didn’t appear terribly complicated.
I began to make my way around the unit, pushing my computer on wheels across the newly buffed floors. The shine put off by the floors did little to brighten the dated unit which always seemed lack luster. Nonetheless, I entered the room of each of my four patients to introduce myself.
It didn’t take long to notice my patient, admitted for observation post surgery had not yet received her flu vaccination. I inquired if she would like to receive it, and she agreed. Being an infectious disease floor, we didn’t tend to see post-operative patients. So, I gladly welcomed her to my assignment, knowing full well there was little to be done.
Moments later I donned my non-latex gloves, drawing up the vaccine from its vial into a syringe. I quickly glanced in her direction, noting big eyes intently watching me. I offered her a smile and brushed her arm with an alcohol wipe, explaining I would be injecting there. As the needle punctured her skin, she instantly shoved her arm away from me in one confusing sweep. I gasped, suddenly noting a burning feeling coming from my finger. I looked down to note the needle had punctured my glove and penetrated my skin. I stared at my thumb, which excreted a tiny bubble of blood, in disbelief. How could this happen? Why would she do that?
My face flushed in embarrassment as I exited her room, her, not even aware of what she had done. Nurses were known for being good at their jobs. There was a sense of pride that we carried. We held it together. We were smart. We did NOT mess up. This couldn’t be happening.
“Maybe I would keep this little incident to myself,” I thought as I tried to brush it off in my mind. She didn’t have much in the way of medical history. What was the harm?
A few racing moments passed, and I found myself blurting out what had happened to a fellow nurse who was more like a second mom to me. She, known for her sound judgment, recommended I file an incident report and perhaps have my blood drawn for good measure. She appeared so calm when I told her what had occurred. Perhaps it wasn’t as bad as I thought.
I made my way to the emergency department, which seemed a little extreme. Did I really need to be evaluated for something not too much larger than a papercut? Even still, it was nice to have a small break from my day.
To my surprise, I was sent right back to the unit. I was required to collect blood from the patient. This came as a shock, given my ED admission bracelet. I never dreamed I would be responsible for patient care while also being treated as a patient myself.  
As I reentered the unit, my heart began to race; and I didn’t know why. This was all routine procedure. There weren’t any red flags. Even still, my hands began to shake. I was relieved to note several nurses gather around me, one helping me get written consent for the blood test and another who volunteered to draw the patient’s blood.
Minutes later and more frazzled than I would have anticipated, I made my way back to the ED where I waited in a small white room for what felt like an unnecessarily long time. Finally, a PA entered in blue scrubs with papers in hand, asking me to describe what had happened. I shared briefly of my mishap, hoping to somehow still appear competent and perhaps even leave with some shred of dignity.
Little did I know what was coming.
His knee began to bounce up and down against the stool as I shared, and I half wondered if I were boring him. I watched his hands fidget as he looked up at me with unsettled eyes and plainly stated, “I don’t know how to tell you this, but her test came back positive for HIV”.
This was not happening.
There must have been an error.
That was not in her chart!
Terror filled my mind and for a moment, I paused, wondering if this were some sort of sick joke. I had heard stories of others on the unit getting stuck by needles in the remote past. I had even learned of a nurse that had gone on to convert to HIV.
Was that going to be my story?
I swallowed hard and quickly made my exit. I needed to get out of there. I felt as if I was being suffocated indoors. I needed to catch my breath. I needed to get a handle on what was happening. Minutes later I looked down to note a prescription for an antiviral medication in my hand, but I couldn’t recall how it had even gotten there.
Everything had gone blurry.
“God, where are you”?
The next few days were a whirlwind of confusion, frustration and nervous anticipation. I stared at the bottle of pills before me. I hated them. I hated what they represented. I already had too many pills to consume. And this wasn’t helping matters.
This wasn’t giving me confidence for a hopeful future.
Over the next few days I called out of work. How could I go back? I couldn’t bear the thought of looking patients in the eyes with the very diagnosis I was trying with all I could mentally and emotionally muster to evade. I had seen too much, and I knew it. I feared it would break me.
Would I be lying in one of those beds someday?
A quiet bitterness came over me in my frustration that I don’t even think I realized at that time. Seized with fear, I left little room for faith. Little room for God. Except to do what I wanted him to do. When I wanted him to do it.
And again, he just wasn’t cooperating.
I did my best to distract my mind over the next few weeks and quite possibly went into complete denial. I was relieved to complete my antivirals, but I knew I was far from being in the clear.
There were labs to be drawn. Several sets over the next year. I knew the first draw would be the most meaningful. And I held my breath in anticipation for the result. There I sat, glaring over the large wooden desk in the occupational health office, waiting to be seen. A few minutes passed, and a stern woman with stiff brown hair entered. I began tapping my foot as I watched her and her grey pantsuit sit down at her desk. This was taking too long. My palms were starting to sweat as I studied her face for cues. She, however, appeared in no rush.
A few minutes of terrifying silence passed. And she finally made eye contact.
“Negative”, she exclaimed.
I loudly exhaled, inwardly collapsing into a pool of welcome relief. I could breathe again. I knew this wouldn’t be the last blood draw. But I also knew it was the best indicator of what the others would also reveal.
I was free.
Or was I?
I left her office that day melancholy, and I couldn’t understand why. I had received a good report. Certainly I should be celebrating. But I didn’t. I wanted to retract, feeling wounded by the entire ordeal.
John 13:7 says, “You do not realize what I am doing, but later you will understand”.
Why had I been so quick to white knuckle my way through this whole process when I could have simply left it in his capable hands?
Was my faith so weak and my heart so hard that in fact I believed he could not really be trusted? Or was my faith just all lip service, puppeting what I had heard my entire life?
Oh to have heeded the wise words of Lamentations 3:25, 28, 31-32, which says, “The Lord is good to those whose hope is in him, to the one who seeks him; it is good to wait quietly for the salvation of the Lord…Let him sit alone in silence, for the Lord has laid it on him…For men are not cast off by the Lord forever. Though he brings grief, he will show compassion, so great is his unfailing love.”
Oh, to wait quietly for him. To sit in silence before the Lord.
He will show compassion.
But it would be a while before I learned such lessons. Really learned them. Deep down in my soul learned them.
Even so, he was extending compassion.

Thursday, January 26, 2017

Three Shuffled Steps Backwards

These past few weeks have felt like one long exhaling breath as we have searched to find ourselves and our lives again. Wondering a bit, where do we go from here? Feelings of numbness, sadness and glimpses of hope have all risen and fallen with the passing of days. A sort of listless ache has come over my heart. An inner battle that I can’t seem to get past. The trauma that we faced has left what feels like an indelible gaping hole in me. The bleeding has stopped. But now a scar remains. I want so badly for that scar to fade. To strike what has occurred from my memory.

But it still aches. And sorrow still smirks in the distance.
I want to get back to living again. Living my ‘real’ life. The way things, in my mind, were supposed to go. Before everything went so…wrong.
I can’t seem to process all the loss and come out unmarred. Even so, I try. How I foolishly try. It seems the moment the pressure lets up a bit and my feet are no longer to the fire, I find I collapse into old habits of self-focus and self-determination. I can do this. I can and will do this, even if it strangles a bit of my spirit in the process. Had I not learned anything about true strength in the past months? More, about my own engulfing weakness? And the beauty found in my own admission of weakness?
Had I so quickly forgotten, “For when I am weak, then I am strong”? [emphasis added]
But the pain has since turned to numbness, and everything that once raged red has now turned to grey. Even still, I can’t help but wonder why I feel such a need to cover to my scar? To hurry up and cover up any and all evidence of ever being broken. Why do I battle day in and day out to get fitter? Get faster. Get stronger. Get slimmer. To control my size. And my family. To control my health. And my rate of healing. To control what others think of me. And how I appear. I find myself even trying to control the exercises given to me by my physical therapist! And for what?
I can’t seem to find my way.
And it frustrates me.
Today was no exception. Trudging my three-year-old and myself to the car, we made our way to physical therapy in hopes of good news. The rain beat down on the car as we drove, and I tried my best to dismiss the growing ache in my right hip. How could this be happening again?
I had just endured not one hip replacement. Not two. But four.
Four. (Three hip replacements and one incision and drainage)
Pain just wasn’t an option I was willing to come to terms with.
Even so, I hurt.
We made our way into the waiting room, quickly sitting down as I waved familiarly at the secretary. Megan hurriedly threw her coat off in one jubilant motion, only to request I sing her favorite, “Twinkle Twinkle” while she hopped and spun about the room. Her eyes, so joy filled, as I sang. So proud of herself as she moved. Delighted to have gathered the affections of the others in the room, she let out a squeal. I watched, proudly, holding back laughter of my own. I was so thankful for this girl and her youthful ability to be fully in the moment. For her sweet joy that flowed so freely, often pulling me out of myself.
Reminding me to get out of my own way.
How I needed that reminder today.
Two minutes later the others had lost interest, and Megan hopped up on the chair next to me, putting her head on my shoulder and exclaimed, “Mom, I just love you in my heart”.
I was loved through the eyes of a child. My child. And wasn’t that enough?
Moments later we were brought back to an exam room where I was told to put on a pair of oversized shorts for exam. As my physical therapist entered, I began to share regarding my recent right hip pain. I watched as concern came over his face. I knew this wasn’t a particularly good reaction.
Over the past weeks he had cautioned me regarding pushing too much and the dangers in overdoing it, potentially leading to injury. He knew I was motivated. In fact, he had tried to temper such motivation at just about every visit, trying to get me to see what real time progress actually looked like.
I breathed in deep and exhaled, not knowing what was coming next.
He stated, “A single hip replacement typically takes six months to return to baseline (with a good amount of hard work).” He went on to say, “A double hip replacement, well those are just tough. But you, you haven’t had a double hip replacement. You’ve essentially had two major surgeries to each hip. It’s going to take some time.”
Take things slowly? Give it some time? These were not things I did well. I already believed the exercises he had given me to be somewhat feeble and in need of a good ramp up.
This was not the promise for complete healing after four months as previously stated by my surgeon, preoperatively of course.
But my gut told me he was right. Even though I hated to hear it.
A few moments passed, and he recommended I use a cane and hold on any more therapy in the interim.
A cane? I thought I was done with assistive devices! Wasn’t that the point of surgery?
Two minutes later we made our way out to the car, Megan, happily singing in the back seat while I was in another world completely in the front seat, mulling over the past hour in my mind. How long would this setback take? Would I ever be free from hip pain? Was there something wrong with my internal hardware?
And then it occurred to me that perhaps I was missing the point.
Really missing it.
Perhaps the point all along hadn’t been to spare me from any further calamity but instead to teach me the true meaning of rest. A part of me cringes even now at fully embracing this, as I have been wired from the start with the heart of a doer. Rest has never been something voluntary for me. I spent years as a pre-med major in college pushing and striving, somewhat cleverly believing God needed me and my achievements. Even after having been diagnosed with lupus, more time was spent pushing and striving towards becoming a nurse practitioner. Sacrifices were made. Anything it took to get things done. But what I didn’t recognize was that my youthful zeal wasn’t actual spiritual progress. Spiritual fervor coupled with holier than thou travel plans to some remote land- not to mention being subtlely aware of the praise that came with said travels-just didn’t amount to a whole lot. Where was God to be found in all of the ‘me’? And how has it taken me so long to recognize this disparity?
Psalm 23 says, “He makes me lie down in green pastures”. Surely, that was a verse I could relate to, having been made to lie down quite a bit over the past years. And still, I wander.
It seems the real power is found in the quiet. In the resting. In perfect trust.
That is where he shows up best.
Jeremiah 17:7-8 says, “But blessed is the one who trusts in the Lord, whose confidence is in him. They will be like a tree planted by the water that sends out its root by the stream. It does not fear when heat comes; its leaves are always green. It has no worries in a year of drought and never fails to bear fruit”.
Oh, to be like this beautiful tree! And even more, to take a lesson from my girl.
Rest, fully present and trusting in him who created us, singing to him always, “I love you in my heart”.
“But I trust in you, O Lord…My times are in your hands…” Psalm 31:14,15

Micah 7:7 says, “But as for me, I will watch expectantly for the Lord; I will wait for the God of my salvation. My God will hear me.”

Wednesday, December 21, 2016

A Lesson from My Bullies

I awkwardly picked up a patient’s blue chart, ensuring the EKGs and other loose papers wouldn’t fall to the ground as I made my way to the edge of the nurses’ station. I needed to not make a scene or mess up. I needed them to believe that I belonged there. Just as much as any other nurse. I inwardly sighed, thinking how was it that I felt I could go on to become a physician when I found the job of a nurse to be so initially intimidating?
“No!” I told myself. That was enough. I could do this. Those types of thoughts had to go. Because that was not how I was going to play the game.
Even still, there was so much to take in. So many new faces. Doctors, PAs, APRNs, nurses, patient care associates, physical therapists, social workers, respiratory therapists, nursing supervisors and so on. So many names to learn and people to get to know. More, it wasn’t just getting to know the various staff members. It was now dauntingly crucial to know specifically which doctor worked in which specialty, so that when a patient’s renal failure was suddenly worsening as noted on urgent labs, I would know which nephrologist to call. Or when a patient’s oxygen saturation status suddenly declined, I would know which pulmonologist to call. Or when a patient was becoming combative, biting and spitting at staff members (which I came to learn was not uncommon on my particular unit), I would know which psychiatrist to call.
How would I ever learn all of their names in such a short amount of time?
My saving grace during those first few weeks was my orientation period. While I had several months of nursing under my belt from my prior job, I was not treated as a seasoned nurse. And while I would have liked the recognition of having had prior experience, I found myself secretly grateful for the chance to start over as a novice. Because truthfully, it all felt so foreign.
It was as if I hadn’t changed specialties but had instead changed my entire career.
Gone were the toy trucks and wagons in the hospital hallways. And no more were the paintings of flowers and balloons spattered across the walls of the pediatric ward. The cheerful colors had been replaced with more solemn tones of beige and the occasional faded blue. And with the change in colors came a sense of gravity I had not yet encountered. An overall sense, deeper than the d├ęcor, that this unit encompassed a vast array of people, each with their own stories of brokenness that I knew nothing about, some having shouldered their secret pain alone for years.
I made my way to the break room, putting away my purse in preparation for my shift. As I passed the nurses’ station I was struck by the sight of a frail older man lying in bed in the middle of the hallway, which I immediately found odd. His bed was adjacent to the nurses’ station, and I was quick to note his cachectic arms were secured in blue restraints. I knew this only happened when a patient needed extra supervision for severe behavioral disruptions. As I walked by him he looked up at me, and I found myself retract inwardly, hoping he wouldn’t harm me in some way.
I immediately despised myself for feeling that way.
How was it possible that I could want to help others (and I knew I did), but then almost instantaneously react in judgment and not love, assuming he would hurt me?
It was a dreadfully eye opening juxtaposition of my ideals versus my current (and lacking) state of emotional maturity.
This new job of mine was going to be a different kind of hard.
Because it was going to unveil some things.
Some ugly things.
Not so much about others and humanity.
But about me.
I had much to learn.
I inhaled deep and made my way to front desk, immediately overwhelmed by the large volume of call bells that seemed to be simultaneously going off. It was change of shift, and I knew I needed to get report from the night nurses before I could start my day. I hated to make patients wait. I found the more I made them wait, the harder it was for me to bridge any sort of relationship with them. Even still, I stood with my computer on wheels, paper in hand, waiting patiently for reports to be given. All the while watching the secretary frantically page nurses and patient care associates to this room and that.
As I waited, I glanced at the white board, listing the patients by room number, diagnosis and attending physician. I sighed, noting we were full, again. I hoped my patient load wouldn’t be too much. A busy day on this particular unit was anywhere from four to six patients. But I quickly came to learn the number of patients one was responsible for often had little bearing on the flow of the day. It was the particular patients that a nurse had, how involved and /or sick they were that dictated how busy one would be. More, one had to be flexible throughout the shift, as there were always discharges, admissions and transfers to complete. So, one could easily go from four patients to six patients in a matter of minutes.
It had been a few weeks, and my orientation period was coming to a close. I had managed to find a way to organize my day despite the chaos that ensued all around me. I wasn’t used to having to think and chart in a loud environment with patients shouting, visitors and staff alike bustling by and codes being called. I was so thankful for those few nurses, two in particular, who encouraged me early on, showing me the ropes and telling me I was doing great. Telling me I was picking things up quickly. I didn’t know it then, but they would go on to become like second moms to me. And our friendships would extend far beyond the walls of the hospital.
But they weren’t all encouraging. Some were cold. And others were stressed themselves to the point that they just simply weren’t able to teach. But I found I learned even still, and in no time at all
I caught my stride.
There was, however, an unexpected toughness to the unit. Something about it that I couldn’t put my finger on. An uneasiness followed me through my shifts in those early days, as I began to pick up on subtleties that I had perhaps initially missed during my training period. While a handful of nurses had been welcoming and fun to work with, I found others to be difficult, showing little interest in getting to know me at all, making it all too clear that they ‘weren’t here to make friends’.
This was particularly evident at change of shift where I was to give and receive report from nurses of varying shifts. I often provided a thorough report including patient histories and past medical problems pertinent to the patient’s stay. However, some nurses were sure to give me wild looks of disapproval, wanting only the bare bones of information to get them through their shift which I often found frustrating and quite honestly unfair to the patients in need of good care.
More, some of the patient care associates proved to be challenging to work with as well. I felt their glares as I sat down one afternoon in the breakroom with a cup of coffee and a salad I had just grabbed from the cafeteria. My legs and feet were weary from having been on them for the past four hours, and I was thankful for a moment to rest. I knew exhaustion had been steadily creeping in, but I did my best to refute it by consuming one too many cups of coffee. I figured heart palpitations were an okay tradeoff so long as I could complete all necessary tasks. And while caffeine didn’t completely energize me, I did find it helped mask things for a while longer.
And I just needed to make it through my shift.
As I sipped my coffee, removing the lid and briefly inhaling the soft scent of French vanilla, I was struck by the manner in which conversations were directed away from me around the wooden breakroom table. It felt intentional, despite my efforts to engage. I exhaled, realizing I had entered somewhat of a hazing period among some of the staff.
Moments earlier I had overheard several of the patient care associates discussing a summer picture I had posted to my personal Facebook page months prior. My stomach turned in hearing their comments, feeling betrayed by these women I barely knew. Even so, it came as little surprise, recalling being faced with bullying since the very beginning in nursing school.
I knew a field predominantly run by women would be subject to the pitfalls of competition and bullying.
I knew I wasn’t the first and most certainly wouldn’t be the last to be faced with such frustrations.
I did however, find it ironic that the ones making it most difficult for me, a few of the patient care associates, were also the ones who were supposed to take orders from me and the other nurses. Even so, I felt no need to establish any sort of balance of power, despite what my nursing professors would have said. I only wanted to show them I was not the stereotypical self-absorbed and superficial tall blonde that they perhaps believed me to be.
Oh, if they could see where I had been!
But I knew they couldn’t. And quite honestly, I wasn’t sure even that would have made a difference.
I knew I couldn’t see where they had been either. I was sure they had been through some things. Some things I knew nothing about.
And given the difficult patient profile of the unit, perhaps these tough ones were needed.
More, perhaps being tough was something they had previously needed to survive.
They seemed to speak the language of the patients far easier than I.
Which humbled me, while also causing me to realize perhaps it was time for me to toughen up too.
Even still, I was determined to win them over.
And in time,
there were a few, I did.

Through My Grey

Over the next few days I scoured the internet for nursing positions. I was eager to learn of all possible job opportunities, imagining all sorts of exciting positions. Would I work in oncology? Maybe the operating room. What about the emergency room?
But my fantasies were short lived and met with the abrupt reality of a limited job market, discovered in only a few disappointing clicks of my mouse. More, the postings that were listed were for full-time work, some for night shift only. It seemed the only floors hiring were medical-surgical units, the one area of medicine I didn’t particularly care for.
I wasn’t particularly fond of tracheostomy care and suctioning secretions, and wound dressing changes were not a favorite task. Even still, I knew I needed a fresh start more than I needed a perfect fit.
I needed to prove to myself that I could do this.
That one woman’s perception of me wasn’t going to dictate the success or failure of my entire career.
More, I couldn’t deny the fire that still burned within me. Ignited all those years ago. With a passion for others. To help in some way.
Any way.
Two weeks later I made my way across the campus of a different hospital. The building sat tall, and people were rushing all around it. As I neared the entrance I quickly glanced down, noting my snow covered black heels. I bent over briefly to wipe off the white crystals and was instantly struck by the sight of a glorious purple crocus poking its way through the wintry terrain. I was immediately captivated by its beauty, contrasting the grey all around.
It was the first sign of spring. And a gentle reminder of the promise of new life.
And perhaps, a new start.
Moments later I entered the busy corridor, struck by the large number and variety of people going this way and that. I nervously made my way toward the elevators, adjusting my blazer just so, praying my interview would go well. Praying there wouldn’t be too many prodding questions.
Why did you leave your last job?
What didn’t you like about your prior place of employment?
These weren’t questions I was ready to answer. Not on any real level. I knew talk of prior discrimination and chronic illness would not bode well, particularly on a first encounter. Nonetheless, I knew I had to come up with a satisfactory response. One that was truthful but perhaps a bit vague. I swallowed hard, silently assuring myself it would be okay.
As I made my way to the unit I was struck by how unimpressive it appeared. The walls were worn, and the floors were outdated. More, there were paper charts and a host of nurses of varying ages. I quickly entered the office of the floor manager, surprised to learn he was in fact male. I hadn’t expected that, given his gender-neutral name in a predominantly female profession.
Perhaps it was a good sign, I told myself.
Perhaps different was good. Different would mean not like my old job.
And I needed for things to be different.
Within only a few moments of talking I was put at ease. He shared at length about the unit and the type of staff on the unit. There was only brief mention of my prior employment, to which I replied I was “simply looking for a change”. I was relieved to note my reply was satisfactory.
As he continued on, our discussion began to feel less like that of an interview and more like that of a sales pitch or even an orientation to a job I had already acquired. Relieved, I in inquired about the types of diagnoses I would encounter on the unit.
It was a general medicine floor.
Or so I had been told.
He paused for a moment and went on to share that while it was a medicine floor, there was a particular focus. I leaned in, curiously wondering what the focus would be.
I hoped it was something exciting.
He went on to say it was infectious disease.
More specifically, the floor was known as the “HIV unit” of the hospital.
While they did take the overflow general medicine patients, it was generally known for infectious disease which in addition to HIV/AIDS included things such as tuberculosis, PCP pneumonia (pneumonia commonly seen in AIDS patients) and clostridium difficile. There were also a good number of psychiatric patients and the occasional patient from prison.
I was stunned, not expecting to hear those words. I tried my best to steady my face. I needed to not have a reaction to this information.
I swallowed hard, wondering if this was something I wanted. Wondering if this was something I could handle.
Was I willing to put my health on the line for this?
Moments later I left the interview. He told me to take a few days to think things over, as this was not the typical hospital unit. As I made my way onto the elevator, I recalled my time in Kenya and working in the HIV/AIDS prevention clinic. Exposure to infectious disease was not a new thing for me. I recalled being mocked by those I knew, some my own family members, for taking such risks. I heard those same voices again in my head as I pondered this new opportunity.
But the more I thought about things, the more I realized there was something about the unit that intrigued me. Something about taking care of the people that others wanted nothing to do with was attractive to me.
Maybe it was because I knew what it felt like to be alone. Really alone.
Or maybe it was because I found I could most identify with those whose lives have been wrecked by the sweeping chaos of debilitating disease.
Two days later I called the hospital to speak with the floor manager. My heart nervously beat in my chest as I attempted to quickly gather my thoughts.
There was one final piece that needed to come together in order for me to accept the position.
And it was a big one.
I needed to tell him about my lupus. More, I needed to tell him I would not be able to work a full-time forty-hour schedule, despite the original job posting for such. I did not elaborate regarding my lupus, nor did I share of my prior job experience. I went on to say I would need to work part-time and would be unable to work night shifts, and if that were a requirement then I would need to pass on the opportunity.
I knew I was asking a lot. I knew I was essentially asking him to create a position for me.
I knew it was gutsy to have even gone to the interview in the first place knowing full well I couldn’t work forty hour weeks.
I nervously paced the hallway of my parents’ home, marching back and forth over the outdated blue carpet as I awaited his reply. While I knew it was only for a few seconds, the silence on the other end of the phone haunted me. I involuntarily began walking faster over the matted rug. I had always hated that rug, with its loud red and gold outdated pattern.
I quietly exhaled, pretending the manager’s response wasn’t about to dictate my future. I silently assured myself that I would make it somehow with or without this particular job. And while deep down I knew that to be true, there was a part of me having recently endured such deep rejection at my prior job that just really needed for this to work. And needed for this to be okay.
A few moments passed, and to my surprise the manager was happy to accommodate my requests, assuring part-time would be fine and that I wouldn’t have to work a single night shift.
How was that possible?
I knew there was only one explanation.
He was making all things new again.
Orchestrating behind the scenes.
Setting out the path for my future which would lead me down roads I could have never imagined.
A wave of thankful relief swept over me as I hung up the phone.
I knew I had no idea what I was getting myself into.
But something told me it would be big. And probably a little scary.
A purple crocus had begun poking its way through my grey.

Friday, November 11, 2016

Passive Aggressive Nursing

Three days later I entered the office of my new manager. She was a powerful woman with a strong presence and a firm voice. I sat with her in her small and overcrowded office with loud blue walls and too many books. I clenched my hands nervously together in my chair, bracing myself for the uncomfortable conversation that was about to ensue. Up to this point, I had done my best to be what I felt was ‘strong’, in hiding my lupus at all cost, even to the point of experiencing additional pain. I wasn’t looking for any handouts, and I certainly didn’t require any extra attention or pity. Nonetheless, I knew I could no longer hide.
My body, having a mind all its own, had decided for me.
And I had little option but to concede.
I inhaled deep and began sharing with her about my lupus, letting her know the changing of shifts from nights to days had been hard on me, and I was not responding well to the change. I was hopeful that she would be accommodating, particularly as I had learned another nurse had recently been taken off nights as she was trying to become pregnant.
Surely, this was a more concrete concern.
Surely, she would understand.
I studied her face from across the desk, searching for understanding, searching for any glimpse of sympathy. But all I saw staring back at me was a blank emotionless face. I paused, as she asked me to explain my lupus more fully. “What are your symptoms?”, she inquired. I shared with her about my joint pain and debilitating fatigue, but she didn’t appear satisfied. I watched as she crossed her arms together and went on to ask, “So what medications are you on?”. I wondered if she was even allowed to ask me that? Nonetheless and perhaps too easily, I complied.
I tried my best to describe the severity of my disease, but something in me told me I was not getting through to her. I couldn’t help but feel I was not penetrating the wall that she seemed to have put up. Concerned, I went on to include words such as “chemotherapy” and “kidney involvement”. Finally, I offered to bring her a doctor’s note to explain my health history along with pertinent labs to which she was agreeable.
I watched as she folded her hands together on her desk, finally conceding to a change in schedule, pending I provide her with the appropriate documentation. But something about our exchange felt off. Something about our exchange felt wrong. While I was thankful to be starting day shift only, I couldn’t shake the awkwardness I felt in leaving her office that day.
I dismissed my fleeting thoughts. Perhaps I was being oversensitive. Perhaps I was reading into things, as was my general tendency.
A few weeks passed, and I had happily started working day shift only. I was thankful to be sleeping at night again, knowing it was better for my overall health to be on a set schedule. I prayed my body would follow suit with the change.
But the shifts were busy.
Busier than I would have liked.
And in the world of hospital nursing, the day shift is known for being considerably more busy and chaotic than that of nights. This was in large part due to the sheer volume of people coming and going on the floor. There were visitors coming and doctors with parades of residents and interns performing their rounds. There were social workers and physical therapists. There were speech therapists and recreational therapists. And there were surgeons and specialists of all kinds coming to check in on their patients, all typically wanting some form of update.
The shifts seemed to be somewhat of a whirlwind, flowing quickly by. But my drives home were often pain filled, as my body was faithful to remind me of my unrelenting disease.
Even still, I told myself this was it. I had made a change, and I needed to make this work.
More, I cringed at the very thought of another awkward meeting with my manager. I needed to not see her for a while. I had to get the sense of the rejection I felt out of my head.
But my pain. My pain hounded me at every turn, interrupting my shifts, and following me down the halls. It screamed at me as I drew up meds and strangled my fingers as I attempted to complete my paperwork in time. A fatigue and general sense of feeling unwell had come over me, and I couldn’t help but wonder if working full time in this capacity was just too much for me.
It killed me to even let myself think those words, let alone have to say them to anyone. And no less, to my manager. Even still, I knew what I had to do.
Five days later, I stepped into that same office a second time, only this time there was another younger nurse sitting there as well. She had been in charge of helping me through my orientation period which I had since completed. I found it odd that she was to sit in on our meeting. I wasn’t comfortable sharing with her about my health information, particularly as she had been less than welcoming since I began working on the floor.
There were a number of younger nurses on the unit, which I initially assumed would make the unit a fun place to work. But I quickly came to learn there was a culture among nurses, one that all too often included a hierarchy and many cliques. More, while subtle and often passive aggressive, there was also a good deal of competition and bullying that took place. I encountered my share of nurses and even patient care associates who tried to intimidate me in this way or that during my time on the unit. I had an older nurse tell me I was “too confident and knew too much”. I wasn’t sure what that even meant. I wasn’t about to apologize for not being insecure. And honestly, while a rude comment here or there was frustrating,
I had bigger things to worry about.
As I entered the office, I grabbed a seat next to my fellow nurse, flashing a quick smile in her direction as I sat down. She looked toward the manager, as if to take her cues only from her. I exhaled, bracing myself for what was to come, already feeling a little ganged up on. Nonetheless, I began to share with them the difficulty that I had been having in working full time. I thanked my manager for having already been gracious enough to put me on the day shift. I then shared that unfortunately my symptoms had not quieted down as we had hoped. I was becoming sicker and would likely need to drop down to a part time schedule of thirty-two hours per week or whatever she had available.
The room went silent. They just sat there, staring intently at me. My manager then went on to inquire as she had in our first meeting, “So, what are your symptoms?”. I obliged and filled them in. She then leaned in toward me, lowering her voice and queried, “Are you sure you are not making this up so that you can have a particular schedule?”.
I was stunned.
It was as if everything froze in that one terrible moment.
I sat there, not knowing how to respond. My heart was suddenly beating faster in my chest, and I heard myself back petal with my words. I inhaled deep, calmly assuring them that I was indeed not looking for a “particular schedule”. I reiterated that I was in fact sick and offered to bring in more blood work if needed to prove so.
I knew she didn’t believe me. I saw it written all over her face.
For the first time in my life, I was being discriminated against because of my illness.
What I didn’t know then was that it wouldn’t be the last.
Defeated, I left the unit that day with my head hung low in frustrated sadness. Was this really happening? My manager told me she needed to look at the schedule and would get back to me. I didn’t know what that meant, but I did know in that moment I began to despise my own profession. This was supposed to be the ‘helping profession’, known for being some of the most caring people in the world.
Was I being unreasonable?
I couldn’t be the first person with a chronic illness to require schedule adjustments.
It just didn’t make sense.
And none of it sat well with me.
Later than night I sat on the kitchen floor in my parent’s house as I had so many times before. I told them of our meeting and the reaction I received. I glanced at the worn linoleum floor as I sat, noting it was cool to touch. I knew I was sad, but as I told them of our conversation, something in me broke. She had no idea what I had endured these past few years. What all three of us had endured.
It had been the fight for my life.
I saw the pain I felt reflected in my mom’s eyes. “She just can’t do this!”, my mom erupted. I knew they were upset for me. I saw it written all over their faces. I heard it in the mention of pursuing legal action, but that wasn’t a course I was willing to take.
I didn’t want revenge.
I just wanted some compassion.
And I knew I wasn’t going to get it from my manager.
I knew I had to make a change. The problem was that she was influential throughout the hospital. I feared her disdain for me would follow me to other units should I make a transfer. And I couldn’t risk that.
No, I needed to start over. Some place new. Perhaps even in a different field. My mind began to wander, considering all the possibilities.
As much as she had hurt me, I knew I needed to forgive her. Even though it still hurt, and I most certainly didn’t want to.
There was no denying. 

It was time to move on.