The View From My Frames

There are frames that embellish photographs, and there are those which enhance a letter page. While some frames cast a protective shadow around an eye to block the blinding ray of a sunny glare, others spark style and glamour onto the eyes that peek through them in order to view the world. Then there is the frame of mind; that intangible ability to see cups half full, to view the good masked in the evil, or even the frame of mind that can see the hope that transcends a disheartened state.

My kind of frames vary; an assortment of numerous shapes colors and sizes. Some are round, others with leopard print, some are metal and some made of plastic, some are funky, or rather crazy, and few are classic. I choose mine to match my outfit, or to bring color, style and individuality to my green scrubbed attire. Some of my frames cover my face more than others, but all of my frames window the eyes that view the discomforts my patients experience, the stress their family endures, the helplessness they feel as they depend on my care, and their hope that can easily shatter into despair. The eyes that blink behind the glass sees a human surrendered to their most vulnerable state; when they are succumbed to dependence, when their fate is unknown, when their dreams of another tomorrow are uncertain.

Curled up in a bed, branded by their birthdate and a barcoded number, a human being with a whole life full of complexities is simplified to a body in a bed, chained to an IV pole, and labeled with a diagnosis. Really they are a power house. They worked three jobs to provide for their kids as a single mom, the world traveler who loves to live life and see the world, and the mother with hopes to continue to expand her family. They clutch onto hopes for their future, as they balance onto the tottering grasp of today.

 As I walk in to each room, I must to see them through the lens of the ill, so that I can attend to their needs and help them progress their capabilities.  I must see a person who needs several medications, and who must rely on me to eat, sleep or move. I see to it that their physical safety is ensured. Behind the glare of my frames are pupils that widen when a light of hope casts a hopeful beam on my patient’s prognosis; it constricts when uncertainties of test results dampen a projected diagnosis. The lacrimal ducts leak tears as my comatose patient’s son sings her a new song he learned that day in school, or when my patient learns that their cancer is back. I must wipe the dust, grime and tears from the glass filling my frames and I go about my day.

          From their bedside view, they see a little person with an ID badge toddling about in her clogs, adorned in green scrubs, and a head of curls that tangle around a rubber stethoscope. Her eyes are hidden behind colorful frames as she looks at the body under the sheets as she introduces herself. She examines the body and shares the plan for the day. What they see, is  the person on whom their life is dependent upon for the next 12.5 hours. This short little, green scrubbed, curly head, crowned with a colorful set of frames; will be their eyes when they walk so they don’t trip over wires and tubing, the eyes that will position them in bed. Those eyes sheltered behind the frames will detect the downhill or upward movements of their state of health.

That being lays there with hope that the eyes hiding behind the leopard, or the bright red plastic frames will sympathize and understand their state. They hope that those eyes can look past the bed, and to the person laying in it, to see the life that lived before the body involuntarily elected to battle an unwanted illness. The eyes behind the frames will utilize their vantage point to see both the needs of the being in the bed, and still perceive what the person was before, and their needs that transcend the medications, diagnostic tests and therapies.  

Really, there are two sets of eyes that are looking through the glass lenses held together by my frames. One set in search of hope and understanding, the other set striving to provide that hope and to understand. Each day, their eyes will meet mine and look through the same glass through which I view them. Each day both sets of eyes strive to meet an identical view.

#Myframes #Nurseinherframes

Who By Fire And Who By Water?

Who will live and who will die?

Who in their time, and who not their time?

Who by fire and who by water?

Who by sword and who by beast?

Who by hunger and who by thirst?

Who by earthquake and who by drowning?

Who by strangling and who by stoning?

Who will rest and who will wander?

Who will be safe and who will be torn?

Who will be calm and who will be tormented?

Who will become poor and who will get rich?

Who will be made humble and who will be raised up?

It is a prayer speaks of the the fragility of life, tradition, ritual and repentance. It is the instructions implicating our destiny, it marks the direction of our future and the cusp of our fate; into the book of life, or death.

Humans can only dictate the pace, and influence the flavor of a final destiny. Spending more time in synagogue this month than I spend in a whole year, the lyrics of the prayers and the meaning of their messages follow me to the bedside. Only hours after speaking this prayer, and sealing my own unknown fate with the Yom Kippur prayers,  I am at the mercy of another’s fate. My profession encompasses the promotion of life, yet often involves chasing the serenity of death. This comes not from a nurse who has been, chilled and frozen to the sadness and emotions of an ending life. It stems from the practicality of the reality, and recognizing the boundaries of my role in such a setting. It is a higher power that determines the fate of my patients; but it is the caregiver at the bedside that can influence the flavor of that fate.

It was only hours after I said the prayer that spoke my own possible destiny; It was the first hour of my shift, and I go in to greet her. She is up in a chair, eating to live,  yet each bite threatens her grasp for a breath, seemingly beyond her reach. I run for medicine to open her lungs, but it will also accelerate her already speeding heart. So now I must weigh the options, what will be comforting or what will delay an already decided fate. I quench her thirsty lungs, with Morphine. She rests, but still with grunting lungs, dissatisfied with the minute tease of ventilation. We call her family, we think her fate has been decided, we think her destiny will meet her soon. She awakens again, her lungs are parched, I quench it with some additional Morphine. And then some more. I moisturize and rub her fragile, paper thin, skin. I attempt to redirect her pain pathways with my touch. As the day progresses, so does the battle between comforting and accelerating her destiny. Who should win?  She grasps my hand, and calls my name. She begs me to let her go, she wants me to help her end the fight. That choice isn't mine. Soon her lungs begin to surrender. We call the team, we call her family close. I feel her pulse and watch her chest rise and fall as it travels on that bumpy, almost lifeless road. I recognize the deadly cheyne-stoke breaths, her pulse weakens and her fingers go cold. Her destiny has caught up with her, her battle is complete.

Man does not decide who will live and who will die; but man can influence how painful the process. We can ease the pain with medications, words, or our caring touch.  

It's is not man who decides who by fire and who by water, but man can determine the type. We can make it a fire of warmth and we can sweeten the water and keep the being afloat with hope until their journey reaches its endpoint.

We can use the swords to advocate and protect our patients like a beast protecting its own from a ravenous prey, when one is alone or unable to advocate for oneself. 

We can satiate the being with hope and we can quench their thirst with the honest knowledge of what their fate may be. 

As the earthquake shatters and drowns all their aspirations with a terminal diagnosis, we touch them and hold them together. We keep them afloat with optimism despite the prognosis that destructs their dreams with an uncertain future.  

We can soften the news that strangles the ties holding onto their faith, and we can buffer the stones shattering whatever remaining desire to keep going with our straightforward, yet gentle honesty.  

We can readjust, massage and make those beings as comfortable as possible, so that they can rest and their soul can peacefully wander about at the brink of life. 

We will hug them so they feel safe, and so their illness does not tear the remnants of their barely beating heart. We will calm them when the fears of the next minute torments their current one. 

We keep their minds rich with dreams and fantasies to mask the darkness and dread that paints their reality. 

We become humbled by their strength, their attitude and their stubbornness, as they hold on to that delicate thing called 'life', as it dangles on fragile, thin threads. Their lingering effects raise us up after they fall; but not before we mourn. Even after they are gone, they help us manipulate the destiny of the next human being cuddled under the sheets, battling yet another mortal fate. 

So who by fire and who by water? Who by cancer and who by heart attack...? A higher power determines that fate and the time it will meet a being, but man may help influence how that meeting unfolds.  With our stethoscopes, we can differentiate a beating heart from a stationary one; but also a beating heart that needs another beating heart to advocate the destiny of its next beat. 

A Singer of Words

He was 60 when he had an ischemic stroke; a blockage in the blood flow to the left part of his brain. With the left side damaged from lack of blood flow PatientX was unable to come up with the right words to form sentences; in medical terms called "aphasia".

After two years of intensive therapy PatientX was still only able to communicate through small words and scribbles on a mini chalkboard. However, his complex verbal communication continued to remain elusive. One day during his standard therapy session. The therapist asked PatientX to sing. Claiming to not be much of a singer, he was encouraged to start with something easy. " Happy Birthday" seemed easy enough, so he gave it a shot. It was the clearest verbal sentence he was able to produce in 2 years.

While PartientX's left hemisphere of his brain was damaged by his stroke, the right side remained fully intact. While the left hemisphere is most largely responsible for speaking, the right is used for understanding, and also processing rhythms and melodies. Through melodic intonation therapy PatientX was able to tap out rhythms and repeat simple melodies through his intact right hemisphere. Using music to tap into the melodic intonations, it activated an existing ability in the right brain that is there but not usually utilized for speech. PatientX knew the words he wanted to say but had difficulty forming the words on his tongue. Music mapped out the directions of his words, and illustrated the pictures of his language.

Working in the hospital on the Day before the Jewish new year 2015, I meet PatientX. A handsome determined singer of words. Each word he speaks is produced through singing in his mind. He tells me that his words are actually music. He sings and I hear words.

We discuss the Jewish new year. I tell him the story of the little farmer to who prayed to God with the sounds of the farm animals. All the members of the synagogue wanted to send the boy out, as his sounds were disturbing their own prayers. The rabbi had them all quiet down and listened intently to the boy's farm animal praying sounds. When the farmer was finished the rabbi said that there was to be an evil decree on that town, but that boy's prayers were so sincere that his sounds reached the ears of God and the decree was annulled. 

PatientX turned to me with tears in his eyes; I hope God hears the tunes of my singing and annuls the decree of my cancer prognosis. 

Much of the Jewish new year is spent praying. While some use prayer books to guide our communication with God for prayers for the new year, others may sing it.  Some of us pray through tears, others through speech, some through music, but to God what is heard is the sincerity of his people seeking blessing for the new year.

Happy Jewish New Year from - #AStrivingNovice  #lunchbreakscribbles

Nurse In The Mosaic of A Living Wonder

Its Carolina weather with random rains that washed away humidity and welcomed sunlight. Its rustic nature, with its steep, swerved, and pebbled roads. Its natural rivers of water, and dirt paths leading to mysterious forests of green nature.  I had just left beeping monitors, ringing call bells and the tunes of bed alarms singing to the movements of anxious patients. I entered the streets of honking cabs, rushed New Yorkers, lost tourists and millions of bystanders. I took a second to observe the comings and goings of a busy city life and hailed a cab; onto a new adventure.  And so, after bouncing and swerving through the windy, pebbled roads, #AuntynurseD entered workation mode in a living wonder. My day job put on hold as work and focus turned in the direction of a special population camping out in the rustic greenery of a North Carolina, wonder filled camp.

Life back at home, as a nurse, was focused on adults who were ill and or had gone through surgery. My healing skills were guided through medications, incision care, intravenous lines and cardiac monitors.

Enter Camp Living wonders.

#LittlenurseD, with her curly hair and big glasses, abandoned her beeping monitors, IV poles and that crazy yellow cabbed city that never sleeps, for an enchanted workation on the rustic yet illuminating grounds of a wonder camp. I faced a new population of special children and their incredible staff. In wonder camp, I didn't play Nightingale and stitch up wounds or act as the angel that chased away pain with a morphine push. Bare of scrubs or a name tag to tell my role, there I was just #nurseypoo. That little girl with the curly hair, who wore different glasses each day and who you went to for meds, cuts, bites, wheezes and homesickness. Medications still deeply guided my workload, but here the strongest healer of the most irritating headache and belly ache wasn't a dilaudid or morphine cocktail, but a chilled Gatorade, salty pretzel cocktail, delivered with a tight hug. Sometimes, just one dose of hug healed the troubles of homesickness, bug bites, scratches and belly aches in these wonder-children.

Part of my job was to deliver medications over a bar counter. The kids called it 'Medline'. I often called it cocktail hour. Some received their meds with a shot of ice cold water, some preferred no ice, and some like to spice up their pills with a sweeter kind of beverage. 'Medline' or cocktail hour although very much guided my daily schedule, was only a minor part of being nurse in wonder camp. My days were often welcomed with 6:00 AM belly aches and wheezing lungs at my infirmary door. Other days, when all the belly aches and stomach pains were still asleep, #nurseypoo pondered on the nature road in a morning run,that was more like a climb on the steep, windy, pebbled road. As I jogged back into to camp I was usually congratulated and cheered on by the 'wonder' early risers. Then the day began; 'medlines', bug bites, dehydration, sprained ankles and occasional wheezes.

The rustic grounds with its sharp edged branches, and rocky hills with dirt path roads displayed an opaqueness over the bright wonders emanating from within the grounds. The wonder was about various and very different worlds colliding in one location; yet its various awkward shapes seemed to mesh itself together in a fascinating mosaic. The awkwardly shaped colorful characters puzzled together in perfect misshaped connections to create the masterpiece; the living wonder family. Each awkward and colorful edge complemented the characters at its side, and shared a connection that ran deeper than a diagnosis, age or background. It were the differences that refined the uniqueness of the final piece. The unusual sound effects, the awkward body movement, and unexpected yet fairly frequent strangled hugs we all got from the campers, added color to the rustic dirt paths and the weeds of greenery.

While some may have gotten dizzy from the amount of pacing that one camper marathoned around our dining room each day, the wonder staff all wished they had the energy to maintain such rapid body movement. We only watched the movement in amazement. One child's queer movements and constant undertone mumbling in a language we knew yet could not understand, made us wish we could walk into their world to hear and understand what that mind was hearing and share pleasure in the exciting things those eyes were seeing. So many words were spoken from the speechless campers. Their body movements, their smiles, and the expressions emanating from their bright yet wandering eyes. Their cries; whether from laughter, pain or homesickness; all spoke an infinite amount more than a perfectly structured verbal sentence, or even the most eloquently written essay. Feelings of love, cries of emotions, and tones of joy, penetrated the air of our wonder camp; they were intangible yet so real. Their presence and character brightened our wonder fields from sunrise to sunset, and until way after bedtime. Each of the campers carried small yet bright lights that are often insignificant sparks in our ordinary world. But their tiny flickers of light united together, with the support of the wonder staff, brightened our wonder world.

A mosaic without out a frame, can look like a shattered mess of glass. But a mosaic sheltered by a fitted frame, can be displayed as a beautiful masterpiece. As the nurse I just dealt with petty external bruises, aches and medication. That left me time to observe from a distance, the internal healers, healers of the souls, frames to our colorful mosaic, and the forces that glinted the light from our wandering sparks; the counselors. Some were still in their teens and others well into their twenties. Some just graduated high school and others had just begun their careers. Yet, in this camp of wonder the counselors were the parents, the friends the advocates, the cheerleaders, the healers, and many other characters; but all with a sole purpose of being there for the needs of every wonder child.

     

          What impacted me most from this experience was how in this environment, no one was singled out to be special or unique, whether they were a counselor, specialty staff or camper. Prior to becoming a nurse,I had worked with these 'special' populations, but they were always singled out as special, and different; but a different that separated them from others. Here, in the world of "Living Wonders", everyone was special and unique, and those who were normally singled out as special or different, were just a camper or staff member treated like any other. The wonder of the camp was the acceptance, the bond and the family. Each individual was just a piece in the mosaic; colorful and irregular, but each additional irregular piece made the final picture complete.

While I see wonders everyday as a nurse, when incisions heal, people relearn to walk after surgery, and pain is chased away; my two week experience as a camp nurse, or as #nurseypoo, taught me another type of wonder. A wonder that doesn't get lost as a distant memory after the patient is discharged and when the bed is filled by another human being. A memory that one is part of does not wither away with time. I am one of the many crooked pieces making the beautiful mosaic of this wonder family. I treasure my role in the making of the mosaic.I cherish the imprint I have made to its final piece, and I value the effect it has etched in me. As I continue to nurse patients each day, I carry this beautiful mosaic on my heart. Each unique shape reminds be that a big heart can be the best adjunct to the strongest medication or therapy, and can do wondrous things; even in a setting of singing monitors and beeping call bells.

     

The Life Marathon

Blood races through arteries, striving to reach hungry cells. The waving flag indicates the “Finish Line” so brain messages can transmit so that lungs can breathe, a heart can beat, intestines can digest, limbs can move; and thus the flag waves on and a life can be.

The strength needed to make it to that finish line increases, and the finish line, all but a foot long distance away. Alternate roads taken to reach hydration to reenergize seem to contain their own barriers. The blood needs an extra push to make it to the water booth, as the veins fight gravity in attempt to drink up on reoxygenated blood for the rest of race. It reaches lungs, sips on its oxygen fix and continues onto the next mile ahead. The body keeps pushing, as the finish line awaits. The heart is thumping, it moves its walls in a strong and steady pace. Lub-dub. Its muscles set in a runner's posture, large strong strides aiming for a longer mile in fewer steps. Messages are transmitted along the heart’s AV and SA nodes, indicating the turns to take and when to take them. Sometimes the lines get fuzzy, and wrong roads are taken, the journey is lengthened, the cells go hungry, some even die.

The brain’s neurotransmitters are the road signs indicating the race’s direction, and maps out the trails to the final destination. At times the messages swapped between neurons play a game of broken telephone and directions are skewed; sometimes they even get lost, and so the body recruits external sources to transmit those messages for them. Often roadside marathon volunteers are called and while one message can get that body up in a swift stride and turn, it takes three bodies (or nurses) to assist or even take over for that road needed to be taken.

The ticking time meter that buzzes the minutes of the race’s time clock, spikes up the adrenaline that surges through the body, and the pace increases with fierce determination. Thus, the fight for life prevails. Sometimes, that clock moves too fast and the racer’s legs can’t reach the finish line before the final numbers tick on by and the meter goes black, indicating the end. Many runners endure, and they make it just as the flag at the finish line begins to wave its way down. Although the seconds ticking the race’s end is battling with their final steps, they manage to hit the mat to a runner’s victory. Even when the ticking seconds flashing on the screen is the victor despite all efforts and attempts of the runner, the entire road taken was witnessed by encouraging cheerleaders and loved ones waving signs and cheering on in support of the race rather than the win. To them the mere living and fighting is a race won. Some lack cheerleaders who knew about their training before the race and just cheer them on as they tend to the safety of the racetrack being ran on They encourage and support the run to live. Sometimes they compress that heart to reboost the marathoner when its heart is weakened and slowed down by the racetrack's obstacles. You don’t need to witness the training to recognize a battle that needs an extra arm, or even a heart for support.

It is my first attempts at a half marathon. Only 3 years ago, I could barely tolerate a run across a block. 1 mile seemed tough, 3 miles seemed like a stretch, 6 miles and my heart might fall from my chest, and 13? Well that wasn't even attainable. Yet here I was, wrestling my way to the finish line of the 13.2 miles.

I’m running a rocky trail, the ground beneath my neon sneakers is a firm, cemented roughness. My stride is steady as my neon gear gently bounces on each graveled bump as it veers in agreement with the trails turns. I pass some runners, and other pass me. Onlookers cheer us on, they tell us we can make it.  I maintain a rhythmic motion as mile 7 becomes a skeptical distance ahead. I reach it, but the battle is not yet won; it’s a mere water break. My mind says I can do it, and so does my friend Anna. My heart is thumping undecidedly, and my legs keep moving. Muscles are aching as they struggle to maintain the pace, but not getting the memo about break time, so they keep moving as I flush hydration down my dry throat. Really, it’s my brain that says don’t stop, and so my limbs abide and my heart gives in. Rehydrated and sugared up, I’m at my halfway point, which seems to have taken forever. I keep going. My legs carry my body with determination. I face some more hills, I must push stronger to keep going. I think about the finish line, with its waving flag, my awaiting metal, and the crowd’s congratulatory roars, in glee of my pending accomplishment. I think of the finish line and I up my pace. I bounce over the hills, I use my fellow runners as my motivation; as their strides boost me up, my legs keep moving and my heart starts glowing. The finish line is visible, I pounce the mat under the finish line flag, legs swing upward in victory, and the metal is placed around my neck. My first half marathon complete, and my heart is still pumping, my legs are still holding up my body, my lungs are breathing and I am still whole.

I wasn't the first one, to make it to the finish line, but I won because I made it to the finish line. As I ran to the beats of my music playing in my ears, my mind was occupied with other marathoners I knew. Not the ones on the track with me in now on New York City’s first day of real spring weather, but the ones I encounter every day. The ones fighting the “Life Marathon”. Essentially we all face the obstacles like those in a marathon. We are victors every day that we wake up healthy and our body with all its detailed cells and parts function to activate a productive and healthy human being. For most people it’s easy, like a simple walk in the park. Many often face an occasional hill and push across it. Some must reroute as roadblocks intersect on their life’s journey. Others face an occasional mountain yet they trudge to the top. There are those who face a cliff, they may jump across it and make it to the other side, or they jump and fall, yet they jump and they try.

I gloat on my 13.2 mile triumph. But my run was like a simple flat road, I simply needed move in order to make it across. I got a medal for challenging my body parts voluntarily. I write this piece as my placing a metal and waving a flag to those who run the “Life Marathon”. To those who are faced with the obstacles of thick capillaries, weakened hearts, handicaps, cancers, traumatic injuries, pain, emotional suffering, and any other mountains, hills and cliffs that make running the marathon of living, that bit harder to make to the finish line, or rather to the next day for it all to begin again. I wave this piece as the flag cheering on all those who muster the courage, despite all barriers, stumbling blocks and hindrances, yet still gear up and run the next road that life presents.

To Touch A Soul

We referred to him as Mr. Comatose.

 His chart had him diagnosed as mentally ill and he was mostly comatose. He was blind. He never spoke. He barely moved. He was a complete care patient. 

He made us wonder. What goes past such a body that neither speaks, or moves nor seems to understand? Do the medications we carefully calculate and administer have a purpose other than just maintain a beating heart?  It sometimes felt as if he were a mock patient like those we had practiced on in labs during our training; except this one had no remotes or buttons that triggered any form of communication.

 Is this where our job is summed into a daily set of tasks and checklists to mark off? It sometimes felt as if we were turning and feeding a product on a to-do list. We wondered if the care we performed for him meant anything. Did he feel pain? Was there anything more than a body? Did his heart feel our touches of care? Did our dedication and devotion to his needs just bounce off his rubbery skin, or did we manage to reach some sort of soul that was perhaps hiding in this stationary statue of skin, bones and IV tubing?

 When we would get into his room to change or turn him, we would chatter about in our daily banter. We would occasionally include Mr. Comatose, even ask for his silent opinion at times. His silence spoke comfort during rough days, his silence helped decide where to go on our next vacation or even which nurse he preferred to turn and clean him next.

  One morning we heard loud, incessant cursing emanating from one of the patient rooms; F*** you, F*** you.  We thought an intruder or a disruptive family member was on the unit and we were about to call security. As we searched for the intruder, we traced the cursing to Mr. Comatose's room.

Indeed, he was alive.

 It was his last day in the hospital, and those were the only sounds we ever heard from him.

Somewhere inside our large and swollen sleeping beauty was a soul crying out in pain. That day the soul that absorbed our nurse banter and our gentle care when rolling and cleaning him, broke out of its silence in thankful curse. His mouth broke out in a passionate f*** you. This time we answered him back with a silent, gentle caress on his shoulder. He quieted down.

Our touch had silenced him.

Perhaps that day we had reached beyond a being with rubbery, swollen skin.

Perhaps that day we had touched a soul.

Reflection of a Nurse Runner

     This past summer I helped treat a young man diagnoses with Guillain Barre Syndrome (gee-YAH-buh-RAYA); a rare disorder in which the body's immune system attacks the nerves. Initially symptoms are expressed as weakness and tingling in the extremities. Those sensations often quickly spread, and can eventually paralyze the whole body. 

     This individual was both a runner and a blogger like myself. His main outlet that allowed him to cope through life, his running, was now the main factor contributing to his illness. To tie in a bit of Neuman’s theory here, his usual Flexible Line of Defense was now his biggest stressor. He could have sobbed his sorry state, but instead joked around and would write a few of his accomplishments at the end of each shift and relay it to the oncoming nurse. This man was determined to walk again, and he did not give up despite the many barriers impeding his way. He would blog about each day in the hospital, and continued to coach his running group from his hospital bed. Any nurse who took care of him was inspired by how he was facing this massive life challenge.

     As I helped this man physically I was motivated to look at my minor daily challenges through a completely new lens. He showed me how to be victorious over the challenges that life throws at you. He used humor, writing, and small goals to keep his spirits up, and to tackle those barriers that prevented him from living life to its fullest; he dealt with one challenge at a time. I was able to connect with his attitude through the similarity we had with our passion for running and writing, and his attitude managed to leak onto me and others who cared for him. He was a physically heavy patient, but our interactions were light. He inspired me on how to cope and confront the challenges that come to hit us both in our professional and private lives. He showed how to optimize what you do have, and what does work; to both cope with and heal the malfunctions parts.

     6 months later I don't know if he learned to walk again, but I do still see his red markings on the runner's road in Prospect Park. Those markings serve as my reminder to run past and jump over the obstacles, and to just keep going. 

     7 miles and 65 minutes later, in freezing NYC winter weather, I jump his red lines, as I complete my run; now ready conquer the rest of the obstacles my life sets in my way .

#reflectionofanurserunner #Delayedtravelerjargon #spontaneouspost

http://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/basics/definition/con-20025832

Tackling Our Supersized Nation; Reducing One Soda Size at a Time

Grande Starbucks coffee, McDonalds’ Big Mac double burger, and Subway's footlong sandwich: Many Americans are unable to recall a day when they did not consume one of these oversized, fattening and high-caloric foods. Easy accessibility and popularity of cheap, tempting, supersized portions, has molded the American culture, the average American’s forever expanding waistline, and compromised the general health status of the American nation. Therefore, in June 2012, when the New York City Department of Health, led by Mayor Bloomberg, proposed a portion cap on sugary drinks, it was met with sweeping opposition from NYC populations, food industries and special interest groups. I will zoom in and examine some arguments and outcomes surrounding the portion cap attempt on sugary beverages, and determine its role on nurses as primary health care providers and advocates in communities managing an obese nation.

Multiple factors contribute to a nation’s health status.With obesity as a significant factor, how can interventions be channeled to tackle obesity? Is limiting portion sizes the best option? While obesity itself seems to reflect a singular health issue, research condemns obesity as a major contributor to more than twenty comorbidities. Chronic health conditions such as hypertension, diabetes, cardiovascular disease, sleep apnea, osteoarthritis, certain cancers, and more issues, can all be linked to obesity (Ferguson, Langwith, Muldoon,& Leonard, 2010). According to the Center for Disease and Control (CDC), nearly 36% of Americans, 20 years or older are overweight and another 69%, are overweight or obese (Ruff, Akund, Adjoan & Kansagra, 2013). Increased body mass index can alter the immune system, thereby making overweight populations more prone to infections (Holm, Spector, Hicks, Carlson, & Lanuza, 2001). Management of obesity among the lists of existing comorbidities has been associated with improvements and resolution of its tailing, secondary health issues. Therefore, controlling the factors which influence obesity may be a rational approach to promoting a healthier nation.

Sugar sweetened beverages (SSB), contain a high caloric density and contribute a substantial percentage of non-nutritious calories to those who consume them regularly. When comparing daily caloric intake with non-SSB drinkers, SSB consumers have a 572 kcal greater intake (Ruff Et al., 2013). Cutting out one SSB a day can decrease body weight by one pound per week (Mayo Clinic Staff, 2012). The link between the SSB magnitude and obesity is significant.

Bloomberg proposed to downsize our supersized nation by restricting the size of SSB sold in public arenas to 16 ounces or less. In doing so, he acknowledged the obesity problem, yet instigated a passionate split in the nation’s opinions. Bloomberg attempted to limit soda sizes to encourage a decrease in SSB consumption, but with an ultimate goal to improve the general health of citizens. Some Americans viewed this as limiting their public freedom. Advocates for the bill claimed it to be no more limiting freedom than traffic lights or other laws implemented to protect consumer rights (Buchanan, 2012). Critics reasoned, that limiting SSBs will not stop consumers from purchasing multiple bottles, but will promote ingestion of greater caloric intake. However, America’s earned title as the ‘super-sized nation’ is not only due to choosing easier food options, but also cheaper ones . The ban may be legitimized, since consumers are less likely to buy multiple 16 ounce bottles than the cheaper 32-48 ounce soda option (Buchanan, 2012).

As the public worried about their freedom and their sugar cravings, special interest groups, such as The American Diabetes Association, strongly advocated this bill due to its weighty implications on their target populations. However, soda corporations opposed the bill. They argued that it restricted public freedom and potentiated financial losses. Large beverage companies, such as Pepsi, were paradoxically supported by the NAACP and the Hispanic Federation. These interest groups both  receive financial support to advance healthier living initiatives from soda corporations (Knowles, 2013). Their claims fixated on financial detriments for local bodegas, and legitimately reasoned to focus more on youth and school based health improvements. As a former supporter of a local bodega, along with my 400 student school population, sugar intake and portions of allowances spent on super sized sodas were significant.

Research indicates that what people want is often influenced by the way their choices are crafted (Surowiecki, 2012). A soda ban would make smaller sizes the default option (Williams, 2013). Ingesting more would then take extra money and effort, thus decreasing overall SSB consumption for the average citizen. While this legitimizes the attempt to manage obesity via control of portion sizes, a primary nursing perspective might choose to target the obesity issue through education and health promoting programs.

Nurse theorist, Betty Neuman's approach to wellness, highlighted the importance of the client's perception of the problem and their agreement with the plan of action (Lowry, Beckman, Gehrling & Fawcett, 2007). Prior to initiating change, individuals must first acknowledge the issue, then nurses can assess how they perceive it (Burke & Wang, 2011).

Organizing programs which educate the public on obesity and its comorbid health effects might self-motivate healthy behaviors. Knowledge regarding sugar’s detrimental health effects will make individuals acutely aware of its impacts whenever they attempt to ingest an oversized soda.  The education may start in schools; when children are taught by example through physical activity programs and healthy lunches, healthy behaviors become second nature (Holm et al., 2001) Initiatives in childhood settings have been and continue to be in effect, but services for adults are equally important so that youth initiatives can be maintained at home (Mello, Pomeranz,& Moran, 2008). Nurses can advocate programs, such as adult obesity management programs, physical activity programs, and influence food industries to expand healthy menu options (Holm et al., 2001).

In March 2013, The Supreme Court of NY ruled against the bill proposal to limit SSB sizes. Bloomberg’s efforts were not in vain. Research indicates that barriers to obesity management reflected both public stigma, which prevented practitioners from more firmly addressing the issue with patients, as well as inconsistencies in health care programs and services (Gunther, Guo & Sinfield et al., 2012). Despite the halt on its passage, the fierce public outbursts of opinions in response to the portion cap attempt imparted by the media unveiled the hush on the obesity matter. With the silence broken, opportunities for nursing advocacy towards implementing and improving health initiatives might have risen.

I’m a runner, and a nurse on a bariatric, surgical unit. I have passion for both nursing and with being fit and healthy. I support any public attempts at advancing health initiatives for our nation. Whether for this bill or against it, all sides had acknowledged that the obesity issue and its relationship with SSBs exists. To the public the bill was a reminder that lifestyle changes must occur. For nurses, it instigated advancement from inertia to active championing for change. For me, it got me running faster, self limited my own version of SSB intake from orange juice or grape juice to simply water and milk, and gave me a topic to share on a blog post.

However, while the proposed bill might have only affected SSB intake outside homes, but not limit attainability for commercially sized SSBs from Costco, Walmart and other industries offering the oversized options, it launched new public awareness on this issue. Our nation’s preoccupation with obesity, increases nurses and healthcare advocates opportunities to inititate more policies to shape healthier lifestyles from an eager audience; the people themselves. The bill proposal was an instrumental start to tackling this nationwide sugar killer, because it seized the public’s attention on obesity. It has now been conceded, that the public will need more than just a soda ban, but perhaps a soda tax, or more voices and actions to stimulate more measurable changes to the waistlines and health statuses of  America’s “Supersized” nation.

*Excerpt from a paper i had written on a healthcare policy that I am passionate about.

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