Watch that First Night. It's a Big One.

Spring fever. Gone.

Winter. Back.

I feel like hibernating all over again.

************

My mind is a bit fuzzy... sleep deprivation will do that to you.

Working nights is hard on the body, but there's no doubt that the first night back is the hardest. I know some who nap before coming in that first night, but my body just won't do it. I try to sleep in for a couple of hours the morning before because that seems to help a bit, but there's nothing quite like being up all day and then expected to function on a highly-skilled nursing level all night as well. To those patients who are sad to see me go, anxious that the next nurse will be a different personality, I am quick to point out, "I am a waste of space after 7:00am... you really wouldn't want me here!" My brain clocks out before my hands can fumble through the motion of swiping my tag.

A few night-shift survival mechanisms that have helped me to make it through:

1. Sleep when you can on your days off... your body will thank you! Sometimes it's hard to switch back and get to bed at a reasonable hour when you're coming off a string of nights, but it makes a difference in the long run.

2. Get regular exercise on your days off... being in good shape is a huge boost, your energy level will be higher all the time.

3. Bring something to munch on in the car on the way home. That drive can be a killer. Literally. For some reason, having something in my mouth keeps my eyelids open.

4. Don't rely too much on caffeine. I've done it both ways, and my body seems to regulate between sleep and awake much more efficiently without. Can't seem to give up that one last cup of coffee... but I've lived on as many as 8-10 cups a day. Say it with me, "Mod-er-a-tion."

5. It's ok to use a sleep aid once in a while, and for some of us, a little Tylenol PM or Benadryl will do the trick. If you're an Ambien advocate, so be it. Just try not to get hooked! And be aware that you may feel a little groggy when waking. It's never been bad for me, and sometimes what I really need is the good, solid (vs. restless, dream-filled) sleep provided with a little medicinal assistance.

6. I'm all about the old-fashioned ear plugs and room-darkening shades. Some people can't stand the feeling of the plugs in their ears, but with boisterous children in the house, I find they're invaluable. And a dark room is awesome, almost tricks your body into believing it IS night-time (key word, almost).

7. Give it time. Eventually you'll get used to those bags under your eyes, and the dull throbbing at the base of your skull. People will stop asking if you're ok, because now it's just the way you look. It's alright... you're a night-shifter... and night people RULE!

Or at least we like to think so, in our delirious, sleeping-while-sitting-up state.

Zzzzzzzzzzzzzzzzzzzzzzz

Sunshine, Happy

Does anyone else have spring fever so bad it hurts?

Despite the fact that we have snow predicted for Thursday, today is a beautiful tease, a happy reminder that inevitably the snow WILL melt, the juncos will scatter to the north, and the robins will return.

Thank goodness for sunshine!

*****

It's an odd world that we inhabit as hospital nurses, particularly on night shift.

Surrounded by concrete walls, ensconced in darkness, our shifts are marked by activity and change, nonetheless. We take vitals, listen to lung sounds, page doctors, deliver babies, regardless of the outside world and irrespective of the late hour.

Usually, we have a vague sense of what's happening outside as the few patients and doctors come and go, remarking upon significant events or weather phenomena. But there are also times when we walk through the hospital doors at the end of a shift, only to find a dense fog, a new layer of snow, a howling wind. The quiet corridors and dim rooms don't always belie these changes, as they have no bearing on what happens within.

Just a thought, as I sit here and soak up the luscious new warmth. My friends who are working today have no sense of this bright sky, this gentle breeze. How strange to think that if I were there, or were sleeping between shifts today, I, too, would have missed out on this brief glimpse of spring coming.

Thank goodness for the reprieve of a few days off!

Spring Forward!

To those of you day-shifters that are grumbling about the shortened night tonight, all I have to say is,

"Hoo Hoo Hahahahahaha!"

(Smug grin.)

We earned it.

See you bright and early tomorrow morning!

Burning, Burning

Here I am, after taking some of my fellow bloggers' fabulous advice, straight off the treadmill, riding high on workout endorphins (and not a little lactic acid!)... burn out? Me??? Never!

Well, okay. I'm trying.

This nursing thing is a roller coaster. A lot like life in general. Good days, bad days. I try not to carry too much of it with me, but apparently am not completely successful in this endeavor. The work dreams are not a rarity. They happen almost every weekend, and occasionally during the week. I'm hoping they're just my mind's way of decompressing.

On the one hand, nursing is a great career. Talk about job stability. They're practically beating down our doors to offer jobs to qualified nurses! I'll always have multiple avenues of practice available if I become unsatisfied with the work that I do now. And I still look forward to most of my shifts, have a sense of camaraderie with my coworkers, enjoy the way my schedule works with my life (most of the time), and am forever in awe of the breathtaking moments my job allows me to witness.

But there are other moments, too. Anyone who has read my blog before can attest to the heavy amount of skepticism I hold for the hospital establishment and the system in general. Paperwork and charting are significantly overvalued in a legalistic atmosphere that reeks of the fear of liability and malpractice. Night shift is great, but my body does not always agree... I've become accustomed to a certain amount of fatigue and fuzziness that never really goes away. And on... and on...

So what, you say?

Nothin' really... these were just a few of my thoughts while burning calories and trying not to burn out.

Things I Can't Live Without

Inspiration strikes! (finally.)


Well, ok. Shane tagged me, so I'm more or less compelled to seek out the inspiration to write... but this was fun, and I look forward to reading others' responses as well. Keep tabs on everyone who's been tagged for this meme at the Nursing Jobs blog.


I had to laugh while browsing through a few of the past "Things I Can't Live Without" articles on Inc.com, looking for that ever-elusive inspiration. The successful business owners who have been interviewed elaborate on the objects of value in their daily professional lives. They *can't live* without a whole lotta really expensive gadgets and gizmos. This is not what I had first planned to blog about when I imagined the most important aspects of my working world. I was thinking more along the lines of: I can't live without sleep, I can't live without the constant intellectual and emotional support of my co-workers, I can't live without hugs from my kids when I walk in the door...




In the interest of sticking to the topic, I'll conform to the heart of the idea. I'm not sure I can narrow it down to just four, but then again, my "things" aren't quite as extravagant as those Inc 500 folks, either. Keeping it simple and honest, here are the "things" that I can't live without:



Dansko Clogs $104.95

I heart my clogs. In all seriousness, I could not live without them, as my feet would likely go on strike. And with the miles I put on every night I work, this is not an option. I flirted with a few months of plantar fasciitis a couple of years ago, and don't care to be debilitated like that ever again. These clogs are awesome, durable, supportive, and best of all... blood and amniotic fluid-proof! They are worth the chunk of change.







At the same time, clogs and sterile blue scrubs are terribly bo-ring! Comfortable, but come ON. It's like wearing unflattering pajamas to work every night. So, I have about a gazillion pairs of fun socks, just to spice it up a bit, even if I'm the only one that can see them. I know they're there.



Johnson's softcream extra care healing hand cream $4.79

The effect of washing your hands approximately 501 times every night? Hands that are raw, chapped, cracking at the knuckles, and peeling between the fingers. Argh! I love this lotion, and it works.


bandage scissors $3.99

I keep a pair of my own bandage scissors in the back pocket of my scrubs, and I use them constantly throughout the night. Who knew that something so rudimentary could be absolutely essential?

clicky pens



Gotta love drug reps. Well, ok, not really. But I do love the pens that they leave lying around, usually transported to L&D in the pockets of the various docs that constitute a steady stream through the unit all day and night. I always like to have at least one "clicky" pen in my pocket... they're more user-friendly and they don't go launching out of my pocket every time I bend over like the regular Bic ones do.



However, I was flabbergasted to find these pens for sale on e-Bay. Hellooooo, people... they're FREE!


Confessions on the Dance Floor by Madonna $12.99



Ok, I admit it. I'm a Madonna fan. I just can't help it. This CD gets me psyched up for working, working out, doing laundry, whatever. When I'm not listening to NPR on the way to work, I'm listening to this for a guaranteed burst of energy.


What I Covet ...

A real vacation. $$$ way-more-than-I-can-afford.99


It's been years. Ideally, I'd love to take a trip to Europe. Doesn't even really matter where... England, France, the Netherlands, Italy, Spain. I'd take any or all of them, preferably with ample time for mindless wandering, lots of picture-taking, exploring castles and cemeteries, visiting museums and lounging at charming cafes. Ohhhhhh...



Who's Next...


I can't resist tagging Kim at Emergiblog. She's one of my favorite bloggers, plus I'm interested to see what "things" she can't live without!

JustCallMeJo over at Sinus Arrhythmia has an insightful and quirky take on the world of ICU nursing. What can't you live without, /jo?

Tag, you're it!

Plus, go check out Beth's "things" at PixelRN. Enjoy!

Count Me In

I want to form a committee.

I hereby volunteer to chair the Committee for Outlawing Committees that Accomplish Absolutely Nothing Except Wasting Valuable Time (COCAANEWVT). Anyone care to join me?

Seriously.

As a *lowly* staff nurse, I am subjected daily to the whims and wishes of upper management. Start a new type of charting starting by this deadline, go to this inservice on one of the above days, try to work amicably with nurses from postpartum when they need your help, don't forget your core ideals, have face-to-face conversations when you disagree with coworkers, make sure you pick up your shoes in the locker room... and on and on.

You might hypothesize that a good way to mitigate this problem would be to join one of the numerous committees that are dependent on staff nurse participation in order provide input and encourage change in the workplace.

If only it worked that way.

Despite the best of intentions, committees with which I have been involved rarely accomplish any tangible change. We spend hours brainstorming great ideas that should improve the flow of our work, the effectiveness of our communication, and the professionalism of our practice. But first we must delegate responsibility for each new concept to a subcommittee, survey staff as a whole to guage what kind of reception this change will receive, propose said idea to management for approval, and create posters and inservices so that everyone will know how to alter their practice.

Oh sure, we spend hours on implementation and evaluation of new ideas. We are congratulated by managers for our active participation in these processes. Thank you for all that you do to improve our unit, blah, blah, blah...

Does anything ever really change? No.

The finance committee has been hard at work. There are reams of paper lying around somewhere to prove that the new charging system in triage is more effective than the old one. Or were the papers used to disprove it? Who knows. And I'm sure the new Good Job forms work infinitely better than the outdated ones. Good thing the central values committee spent weeks on that. Now, how can we solve the problem of inadequate staffing during peak scheduled procedure times? Let's send an OB tech to the recovery room to help and make the secretaries do baby baths. But we'd better filter that idea down through the OB tech and secretary committees.

Last item on the agenda: the inconsequential issue of low staff morale and poor RN retention?

Let's pass that one on to the shared leadership committee. I'm sure they'll have that one solved in no time.

Meeting adjourned.

MAGNETism

I am ambivalent about my hospital's claim that we are seeking Magnet status. You can find more information about this designation here.

At times, I feel inspired to aid in the effort, certain that if we can find enough like-minded colleagues to work towards positive change, we can make it a better workplace. I am often proud to acknowledge that I am part of such an esteemed institution, that we can provide professional, highly-specialized and complex, but heartfelt, individualized care to a high volume of patients. I assume that my fellow nurses choose to stay because they, too, appreciate the high expectations and abundant opportunities inherent to a large teaching facility.

However, there are also times when I am discouraged by the ridiculous processes and mindless functions of the executives and managers who spend so much time talking in circles and sitting on committees that accomplish nothing. How can we effect change if those in leadership roles care more about the statistics than they do about the people "beneath" them who are daily offering their blood, sweat, and tears at the bedside? I wish I could say that we have a cohesive team from top to bottom, but I am constantly reminded that this is simply not true. There are an abundance of petty battles being waged at any given point, with very few satifactory resolutions made.

To my fellow bloggers: Do you work for a Magnet hospital? I would love to know... how is it?

=======

A few other random thoughts:

-------

It was an incredibly busy weekend. Low staffing didn't help: it would not have seemed quite so out of control with a few more warm bodies present, but we made do (as always) with what we had. Now that all the holiday celebrating has ceased, we have settled back into the normal routine... busyness as usual. Today feels like I'm recovering from a marathon: achy head, sore shoulders, heavy eyelids, sore throat. I still didn't manage to get a pedometer for Christmas, so I'm not sure how many miles it was this weekend. It felt like at least a marathon's worth!

-------

As a charge nurse, I often step into the room for the actual delivery, to make sure that there are enough hands available and that the newborn can receive any extra care if necessary. Sometimes I miss having a close bond with one patient and seeing her through the entire experience, but it is thrilling to be present for so many of those most magical of moments. Within an hour and a half the other night, I witnessed a natural (and naked) birth that was documented by a professional photograper and videographer, the birth of an undiagnosed Downs Syndrome infant, the birth of a first child after days of labor and hours of pushing, and the birth of a sweet babe with a previously diagnosed cleft lip and palate.

Sigh... our bodies are so amazing. And sometimes they betray us, but that's a post for another day.

I am a Nurse in Real Life... And You?

As I gorged myself on primetime TV tonight, a novel idea occurred.

What is the big deal with the way that nurses are portrayed on television? Get over it.

Granted, most of us are probably already over it (or were never under it), but seriously. The Center for Nursing Advocacy has an interesting and aggressive take on the issue. My question is, why does there need to be an issue? The Center's website riles against popular medical dramas, like Grey's Anatomy and ER, for grossly misrepresenting the role that real nurses play in real life.

Therein lies the thing. TV is not real life.

I enjoyed the shows I watched tonight... for their entertainment value. For the laughs and the tears. TV is a form of entertainment. Real life, it is not.

I watched a pair of TV "cops" conducting an investigation; their laughable interrogation of a suspect, highly contrived police conversations are completely stereotypical, but that's okay because... it's TV.

I watched a newly pregnant TV character, whose doctor told her at 12 weeks that he may be able to determine the sex of the baby on ultrasound. Uh-huh... NOT. Except on TV. She then proceeded to stuff her face with every morsel of food in sight for the rest of the episode. Kind of annoying portrayal of a fairly inaccurate pregnancy stereotype. Oh, well... it's TV.

And so.... hmmm. While I admire the Center's noble attempts to "increase public understanding of nursing", I'm over it. I'm comfortable with what and who I am, no matter how it may perceived by the public or portrayed in the media. And you?

You Don't Say.

We all have work lingo... in the health care field, the jargon can be particularly mind-boggling. On L&D alone, we drop acronyms all day, from PPROM, SROM, AROM... PTL, PUPPS... to IUGR, PIH, GDM and HELLP... from EFM, FHTs, LTV, IUPC, and FSE..... to SOL, PDI, ROP, LOA, and RC/S... along with Michelle Murray's brilliant and oft' repeated TFTF (too fat to fit!).

But it's the other phrases that fascinate me... the ones you won't find in any medical terminology text book, but which need no explanation among L&D staff.

A few examples that come to mind:

"They're wheeling her up from ER 'cause she's one-cheekin' it down there."
(Patient can't sit straight on the wheelchair. She's probably already pushing, so lets get a room ready for delivery.)

"She's got a positive wet wheelchair test so we're bypassing triage."
(We can be sure that her water broke because she's wet all the way through her pants and onto the wheelchair.)

"I think she's gonna need a little vitamin P."
(Her labor sucks, and it's time for some pitocin augmentation.)

"She's gonna need a zipper."
(She'll need a C-section.)

"She ended up delivering the vaginal bypass route."
(She had a C-section.)

"Can someone bring a glass of orange juice in for ______?"
(_____ is about to pass out... probably mid-epidural placement... and needs a little sugar boost.)

"Call the clinic doc to stand by."
(The patient's physician probably isn't going to make it in time for delivery, so get an attending nearby, just in case.)

Last, but certainly not least, the always-adrenalin-inducing:

"I need another set of hands in here!"
(Something's going down the tubes fast so somebody get your ass in here!... without completely freaking out the patient or FOB.)

Occasionally, this one is followed by:

"Tell them to open the OR!"
(self-explanatory.)

Give Thanks

It's a day to reflect on all that we are thankful for.

I am thankful for the calling to a noble profession dedicated to helping people.
I am thankful for the opportunity to make a difference in the lives of families every time I go to work.
I am thankful for the tremendous moment of birth when the ultimate outcome is truly out of our hands, that blink of an eye in which a tiny life begins... and is both completely dependent yet must breath and suck and pump blood all on its own.
I am thankful for the technology and advances in medicine that allow us to help sick moms and babes.
I am thankful that most deliveries require no such technology.
I am thankful for the team of dedicated nurses and other staff members with whom I work, the people who make work more than bearable, the ones who fill it with laughter, smiles and enjoyment.
I am thankful for the instances when there is no laughter or joy, when life is at its rawest and most real.
I am thankful that I can return to the loving, understanding arms of my family and a warm, inviting home.

Happy Thanksgiving.

the Sandman Cometh

I love to sleep.

As I snuggled between the covers and closed my eyes the other night, this thought superceded all others in my mind.

I love to sleep.

And night-time sleep is somehow so different than sleeping after working all night. I thrill at the chance to climb into bed along with the rest of the "normal" (i.e. daytime workers) world.

I'm not sure that people who exist primarily in the daytime can actually appreciate the extent to which a night-shift worker can long for sleep, the way we ache to stretch out and feel that release. Granted, I have a few kooky co-workers that only require a few odd hours of sleep after working a 12 hour night shift. I am NOT one of those people.

What can I say? I love to sleep.

Due to some scheduling changes, I have an extra stretch of nights off over the course of this week. While I would normally start to readjust to a daytime schedule at home on the same day that I have to go back to work, this week I have a few extra days of "normalcy". I feel like my perpetually foggy brain has cleared and that I have a ounce or so of energy and motivation when I usually would not. It's amazing how our circadian rhythms rule us. And how we throw them out the window for necessity's sake.

Night shift definitely has its perks. Lack of sleep is NOT one of them.

Food for Thought

How not to make friends with the Neo charge nurse: give her a 28 weeker, 30 week twins and then 30 week triplets over the course of about 4 hours.

Huh.

I'll try to remember that one next time.

Probably best not to mention the 26 weeker with a bulging bag at this point, huh?

Family Nurse Extraordinaire... otherwise known as a Comedy of Errors

As a nurse, you can and probably will find yourself appointed the Family Health Expert on any and all health-related topics.

I should know. I have spent the last day and a half proving the point.

It seemed simple enough at the start. Grandmother (GM) calls me and says she thinks she has a bladder infection and has been trying to reach her physician to call in an antibiotic prescription (I know, eyebrows raised) but just can't seem to get the phone call to go through. Little did we know, making the connection would be the least of our problems.

GM: "I listen and then I press 1 and then I don't know what happens."

I can just imagine... did I mention that GM is 99% deaf? She gives me the name of Her Doctor (a phrase we can use loosely here considering that she has seen him face-to-face ONCE... did I mention that GM also has a serious doctor phobia?). This physician has changed practices since she saw him... but, no biggie, right? (HA!)

me: What phone number have you been calling?
GM: "Um, I don't know... I can't seem to find it here, but that doesn't matter. It wasn't working anyway."

Uh-huh. Family Health Expert to the rescue.

I get through to the office without difficulty. However, it is now 12:32 pm and their lunch break started at 12:30. Perfect.

I call back at 1:30, and, after a brief explanation to the phone nurse, I'm given the phone number to Her Doctor's New Office. Okay.

Call to New Office.
Repeat brief explanation of situation.

Phone nurse: "We'll need to get GM's records transferred here and have her sign a release. Would she like to do that today?"
me: Ummm, considering that GM lives more than half an hour from your office and has a doctor phobia... no. (in so many words)

Call to Old Office.

me: Could you please fax pertinent records to New Office and GM will sign a release when able?

Thank goodness the answer was yes.
Call to New Office.

Phone nurse: "Oh look, we found GM's records. They were here all along because she signed a release when we switched practices. However, GM has never been here and Her Doctor is out of the office this week. We'll need to see GM."
me: Ummm, no. (insert brief repeat explanation of GM's doctor phobia and fact that she lives more than half an hour from New Office.) Can we please have her leave a urine sample at the hospital lab here in town?
Phone nurse: (and really, she was very accomodating, all things considered) "Let me check with Her Doctor's New Partner."

Apparently, Her Doctor's New Partner does not have priveleges at the hospital here in town, so one way or another GM would have to drive to the next town up in order to get any help from New Office. ARGH. (That last part was unspoken, but definitely heartfelt.)

Next step, half hour conversation with GM regarding whether or not to stay with Her Doctor and drive to New Office out of town, or switch to someone else at Old Office here in town. After much hemming and hawing (I'm talking MUCH here... due to GM's hearing difficulties, I must repeat virtually every sentence at least once), GM decides to switch to someone else at Old Office. Okay, now we're getting somewhere.

Call to Old Office.

me: Hi, it's me again. GM would like to switch back to your practice (I can almost see Phone nurse rolling her eyes at this point)... would it be possible for her to leave a urine sample at the hospital here in town so that she can have an antibiotic called in if necessary?
Phone nurse: "Yes, but you see, we no longer have GM's records, so she'll need to sign a release and have them transferred back from New Office."
me: (muttering under my breath for a moment...) Okay.

Call to New Office. (by this time I'm not even sure who's who... I'm just glad they're still willing to take my calls.)

me: Hi, it's me again. GM decided to seek advice at Old Office. Could you please fax pertinent records there?

Again, the answer was yes. Sigh of relief.

Next step, explain to GM that we still need a urine sample. If she drives to my house, I will take her to the hospital lab where she can give one. No problem.

I proceed to wait for another half an hour or so, expecting GM to show up at my house. At this point, she calls me.

GM: "Well, I got about halfway to your house and it got really foggy. I started thinking about how long I'm going to have to sit in that doctor's office, and I really can't be driving home in the dark. So, I turned around and came home. I think I'll just wait it out. After all, it's not really that bad."
me: (pause for silent scream) GM, I really think you should do this. I'll come and get you. And you won't have to sit in the office. We're just going to go in so you can pee in a cup (at this point, I really did use the words "pee in a cup" with my Grandmother... yikes.).
GM: No.

Call to Old Office.

me: Yeah, it's me AGAIN. I'm very sorry. You're not going to believe this, but GM does not want to come in today. She agreed to call or come if anything gets worse. You see, she's got this doctor phobia...
Phone nurse: You know, I think I remember GM.
me: I bet you do.

End of story, right? Wrong.

Over the course of that evening and the next morning, there were a few intervening phone calls from GM, reassuring me that she's feeling just fine and thinks that her discomfort will probably go away if she keeps up with the water and cranberry juice, also informing me that "if it gets really bad in the middle of the night, I'll just call 911." She said it so matter-of-factly that I really thought she was kidding. Not so. And I'm fairly certain that I did not dissuade her from that plan, despite my attempts to make her promise to call me if anything were to happen during the night. ("Oh, I wouldn't want to wake you up!" Little does she know, I'll probably lie awake anyway, wondering if the fire department is being summoned to the home of a little 88-year old woman with a UTI.)

So, next morning... not half an hour after calling to inform me again that she's feeling just fine and she'll call me if anything changes, she calls back and says that she was talking to a friend who informed her that the weather is supposed to be nasty for the next few days, and perhaps she should just give the sample and get it over with before she can't get through on the roads.

me: (gasp of disbelief and slap to forehead...) Well, sure. (thinking, Why didn't I think of something like that?!)

After all that fuss, GM came to my house and we went to the hospital lab and she gave the sample.

End of story.

For now.





Thanks to Dr. Dinosaur and the link to him at Grand Rounds for a little inspiration this week. :)

Now, That's What I'm Talkin' About!

One of our anesthesiologists had a relative in labor last night. The guy must have learned a thing or two in all his years of practice... he magnanimously slipped a wad of cash to one of the nurses at the desk and had her order pizza for everyone on (have I mentioned that we have at least 20-25 nurses working L&D at any given time?).

Good man.

Why do we do what we do?

Do you ever feel like a glorified waitress?
I sometimes ponder why we put up with all the baloney. (I'm being diplomatic and politically correct here, in an attempt not to offend those who don't yet know me well enough. Please substitute the actual term I'd like to use in place of "baloney"... use your imagination.)

And does the baloney outweigh the reward?

Would it make a difference if it did?

Men and women enter nursing careers with astoundingly different perspectives and motivations. Certainly, there are enough different nursing fields and forms of practice to satisfy our diverse expectations, but why do we so often "stick it out" in challenging and mediocre work environments?

Honestly, I don't have a global answer for that one and would not presume to venture a guess.

More about the baloney later, I'm sure, but here are a few of the reasons I continue to show up for my shifts (occasionally with bells on):

1. I have to admit, it feeds my family.

2. Most of my co-workers are admirable (if often inexperienced... yes, I do work nights), and we've worked together through those nights from hell, laughed at each others' nutty 5am slap-happy stories, smiled and cried with each other over the joys and tragedies in our personal lives, and managed to keep the unit from completely falling apart at any point to date.

3. The sense of pride and accomplishment when new nurses look to me for help and mentorship... then over time transform into "experienced" nurses themselves.

4. There's nothing quite like the adrenaline rush of a scary or fast delivery. There are those of you who know, it is indescribable.

5. The absolutely unforgettable moments I've spent with close friends who've asked me to be present at the birth of their children, which brings me to perhaps the overwhelming reason I stay:

6. (pause while I sit here and struggle to begin...) I'm having difficulty putting this one into words, but I want to convey my understanding and acceptance of the fact that what I do (help bring babies into the world) is utterly miraculous. I am present at those moments in a family's life that bring both the most anticipated and the most unexpected joy. I also stand by as families experience the most heartbreaking and unspeakable grief. To witness these pivotal moments is both a privelege and a burden, but is definitely one of the most influential factors in my faithful return to the unit, week after week, year after year.

I'll close on that note. There are perhaps innumerable other reasons to "stick it out". Sometimes, it feels as though they are not enough.