Saturday, June 24, 2017

Tips for Introverts

Dear Emily,
How does an introvert beef up their people/conversation tolerance when working in an interaction-heavy environment? 
– Asking for a Friend

Dear Friend,

I love this question so much. Here's my best advice (which I am saving for my own future reference).

Give Yourself a New Context

Instead of picturing yourself as a square peg trying to fit into a round hole, separate your job title from your identity. If you can think of the tasks that belong to your role as opportunities to gain additional skills, the number of hours spent at work are much more tolerable.

Think of yourself as being enrolled in a tuition-free program for personal development. Ask yourself, “How can my current role prepare me for a future role?” This makes introversion one more tool you have at your disposal, not a character flaw to overcome.

Practice Extroversion

Act like an extrovert for a specific period of time. Experiment with the things extroverts do: initiate conversations, give verbal greetings, smile, ask questions, narrate your actions, maintain eye contact, etc. In other words, make yourself open to interaction, whatever form it may take.

Maximize your own daily rhythms – if you’re not a morning person, don’t practice before your first cup (or two) of coffee has kicked in. Don’t launch an extrovert expedition during your post-lunch slump. Be intentional in your availability but be realistic. Give yourself a hard stop. For example make “extrovert skill building” the last hour of your work day. If it becomes totally intolerable you can just count down the minutes and then run out of the building.

Document Your Findings

Start a list of the things you discover while exploring the world of extroversion. What discomforts do you experience? What triggers your curiosity? Play the role of investigative journalist conducting your own research. Find an audience to share your findings with.

Explain Yourself

Educate the people around you about what it's like to be you. Identify yourself as an introvert and, given the opportunity, explain that this doesn’t mean you hate people, it just means extended periods of time with people is exhausting. Inform your co-workers that you need time to rally between meetings, following a presentation, or after an intense period of productivity. Give yourself permission to end conversations.

People who want to brainstorm with you want your input, but don't know how to ask for it. Thank them and then let them know you need time to think. Say out loud, “I want to give this my full attention. Can I get back to you later this afternoon?” or “Can I follow up with an email?” or “Let's schedule a meeting for this conversation after I’ve spent some time with the topic.” This gives you time to figure out what the heck they’re talking about and not feel put on the spot.

Start Small

Increasing your tolerance for conversation is not like dieting: you can do it intermittently and in small increments. On a diet, one tries to replace everything they eat with healthy options. Deviating from the plan can lead to downfall: an isolated incident of sugar intake can sabotage the whole thing. Not so with the introversion/extroversion spectrum. Between chatty interactions, you can still close your door (if you have one) and be quiet for 30 minutes without losing any momentum (in fact, that mini recharge of solitude will help you with the next conversation  – that’s the beauty of being an introvert!).

Give Yourself Practical Support

  1. Schedule down time so your calendar shows you are unavailable during tasks that require concentration.
  2. Put yourself on time out: take a walk, find an empty room to meditate in, sit in your car, hide in a bathroom stall, drive to the nearest plant nursery and look at seedlings, eat lunch in a restaurant by yourself.
  3. Note the length of your next verbal exchange. How does the actual number of minutes you spend talking compare to the amount of time spent pining for privacy? Don’t psych yourself out with expectancy or dread.
  4. Summon the strengths of your alternate roles: Patient Parent of Toddler, Artist, Musician, Free-Lancer, Diplomat, etc.

Plan for Spontaneity

Choose a designated amount of time to sit in the lunch room and engage in conversation with whoever happens to be there. Like a real-life Choose Your Own Adventure, every exchange with a co-worker will add to the plot. See what wild and wacky things you learn just by being available.

Dodge the Spotlight

One of the most disconcerting things about being surrounded by extroverts is EXPOSURE. Continuous interaction feels like I’m failing a test I didn’t have time to study for (or even write my name on). When an extrovert initiates a conversation, respond with a question of your own and pay close attention to the answer(s).

Introverts make good listeners because it's in our nature to be silent and allow space between topics. Extroverts fill that space with lots of noisy chatter. Use the shift in attention to move the focus off of you. You’ll still be engaged from a position of listening – the introvert’s secret weapon.

Crowd Source

  1. Partner with a fellow introvert who can give you thumbs-up, raised eyebrow approval, or emails of encouragement as they overhear you yukking it up with the office chatterboxes.
  2. Ask your boss or another supervisor you trust for suggestions. Experienced managers who are effective with their teams may have additional ideas. 

Tuesday, June 6, 2017

Birth Story: Part IV

Part I
Part II
Part III

Part IV:

My Friday day shift nurse was awesome. She brought me and Hubbins water with "His" and "Hers" written on the cups with Sharpie. She said "I Pinterested them for you!"



My Friday night shift nurse was a familiar face! It was the same nurse from Tuesday night when I first arrived. It was so good to see her again. She advised me to push my epidural-dosage button whenever I felt pain so I could get some sleep. "You're going to need all your energy tomorrow for pushing!" she urged. "Try and get some sleep."


Friday night, June 5th - updating family via text

Friday night, June 5th - "Let's get this show on the road!"

Before turning out the lights for the night, Hubbins reminded me that tomorrow, June 6, was D-Day. On our phones, we looked up Eisenhower's letter to Soldiers, Sailors and Airmen. Those powerful words touched us both and we cried together, exhausted from our own experience and imagining such a solemn send-off before battle. I took encouragement from these lines:

I have full confidence in your courage, devotion to duty and skill in battle. We will accept nothing less than full Victory!
Good Luck! And let us all beseech the blessing of Almighty God upon this great and noble undertaking.
We looked at each other. "The name 'Eisenhower' has a nice ring to it," Hubbins said. We had narrowed our list of names down to five possibilities (from which to choose a first and middle name). We wanted to meet our son before deciding and now the list grew to six possibilities. I grinned at the thought and said, "I like Ike!"

Sleep was still elusive. I couldn't easily lay in any position except flat on my back. All the cables and tubes connected to me made any kind of movement difficult. I had to get help to position the hospital pillows comfortably (they were so thin and slippery they didn't stay put for long; plus the sanitary covers crinkled every time they moved). At midnight I had my regular blood draw and then tried to sleep. My nurse kept me supplied with ice packs and water. Baby continued to kick the heartbeat monitors off my belly so they had to be adjusted several times. I don't remember getting any sleep, but I must have dozed for a few hours.


Saturday morning, June 6th 
At 4:00 a.m. just as the pre-dawn light began to filter into our room, one of my doctors came in to check on us and share an update. She said baby sounded good from the overnight monitoring but, she said solemnly, they were starting to get concerned "that things weren't progressing fast enough." After a quick exam, she discovered that my water had broken and I was only dilated to six centimeters. She "tickled" the top of baby's head (her word. And please don't picture that). She didn't think he was low enough in the birth canal (that darn cervix!). She explained that she and the other doctors would be meeting that morning to discuss their patients' conditions. She would check back with me soon once they'd reached a verdict.

The next two hours were the darkest for me, waiting to hear what the doctors wanted to do. I never feared for my safety or baby's. With as much monitoring as we were getting, I knew not even a hiccup would go undocumented. They'd tried every trick in the book for inducing labor. But I was exhausted. I was cranky. I had not mentally or emotionally been prepared for the education I received in the previous few days.

I told my nurse I could still feel contractions. She said that shouldn't be the case and before handing me off to Saturday's day shift nurse (another new face), she called for the anesthesiologist to come back in and increase my dosage. He had to give his blessing since I'd reached my limit with the self-administered doses via auto-release button. My pain-killing robot had cut me off.

A new pair of anesthesiologists (high-energy, talkative female resident and somber male trainee) came into the room and started their assessment. The trainee (younger and less personable than Ethan-Hawke-Look-Alike) prodded my right hand and arm. I couldn't figure our why he kept patting me, trying to get a vein to show up. "Surely I'm hydrated enough, this shouldn't be an issue," I thought. Everything else had been explained so explicitly, I just assumed he was working on the pain killer. I was so exhausted I didn't even know how to formulate a question.

Unbeknownst to me, the IV I had in my left hand since Tuesday evening was about to expire; apparently one location can only be used for so many days. What I didn't understand was that I was too hydrated - I was pumped so full of fluids he couldn't find a spot for a new IV site. I cried after he tried for 10 minutes to find a vein. I didn't understand why this was necessary when I already had an epidural port in my back. The resident had to take over and I sensed non-verbal conflict between the two of them. It's fully possible I was so hypersensitive that I created this narrative to match my level of exhaustion and frustration. Regardless, I was annoyed that they weren't communicating well with each other (in my estimation) or with me. 


The day shift nurse asked me abruptly why I was asking for more drugs. "'Cause my butt is completely numb, but I'm still feeling contractions - I don't think I can do this."  I felt like I had to justify my request which also irritated me. She emptied my catheter loudly (a terrible sound to hear in the best of circumstances) right in the middle of all the commotion, while the resident anesthesiologist repeatedly swatted my bruised and battered arm, looking for a cooperative vein. She eventually found one and re-ported me for future IV use. 


The second nurse on duty (called preemptively for baby) was less abrasive, but started questioning the first nurse's judgement and they bickered over who should do the next blood draw:

"I can do it, I see the order right here."


"No, just wait for phlebotomy - they're the experts."

This was very disconcerting to overhear. I felt like I had been stuck with Sleeping Beauty's fairy godmothers as nurses, without the privilege of actually being asleep. Or beautiful.


The doctor finally came back in - it must have been an early consortium with the other doctors, it wasn't even 6:00 a.m. yet. She re-explained the situation, the risk-benefit analysis, and the recommendation to proceed with a Caesarean section. Three days of trying to induce labor was starting to feel like three months. The good news was we'd made it to the 34 week-mark. I could feel tears rising again (that back-of-the-throat, I-am-going-to-lose-it sensation). I interrupted the doctor: "I don't care what happens next, I just need a decision to be made. Let's go."

Then the pace changed completely. Up next: C-section. The medical team sprang into action. They suited Hubbins up in scrubs and a hairnet. They wheeled me, bed and all, into the operating room. I don't remember how or when, but I started to go numb from the armpits down. I was lifted onto the operating table. The sensation of movement made me feel like I was falling - I braced myself against the table with my arm, as if I could support all my own weight. Of course I wasn't falling, I was completely supported, but it was mentally jarring.

Best-dressed father-to-be!
They spread my arms up by my head as if I was back-stroke-flying and strapped my wrists down. The nurses set up a little partition across my ribs - like a Johnson family camping trip in a leaky borrowed trailer, a blue tarp was my wall of protection. I couldn't see anything beyond the barrier at my chest. Hubbins sat behind me, and held my left hand. The female resident anesthesiologist who had recently irritated me so badly, was now my best friend. She held my shoulders and stroked me gently, reassuring me and explaining vaguely what was being done. Peaceful spa music played in the background. I chuckled to myself. Oh University of Washington, you've thought of everything. But I wasn't fooled. This was no deep tissue massage.

One of the doctors began narrating the procedure, naming me and the staff present for the sake of medical records, I assume. It was just like a movie: bright lights shining from every imaginable angle and a team of medical professionals in matching scrubs encircling my abdomen. I felt bathed in that sweet antiseptic smell as waves of adrenaline heightened my senses and anesthesia immobilized me completely.

All those drugs did what they were supposed to. I was unaware of the exact proceedings (though I heard the teaching doctor coaching the medical student, "Make the incision right there. Yes, that's good"). Holy crap. Experiential learning as a teaching method suddenly seemed like the worst possible idea. Too late now, I was in no position to offer my professional opinion on needs assessments or learning transfer.

My anesthesiologist-BFF asked me about our pets. I gladly bragged about Ivan and reported what good snuggle-care I'd received before being admitted. Spending Monday on the couch at home in Bellingham seemed like a lifetime ago. Hubbins continued to hold my hand, my strong and silent support in chaotic times. Without realizing it, I had a death grip on him. He tried to adjust his fingers to avoid my wedding ring and thumb ring which were pinching him. I sensed his movement and gripped harder, a non-verbal plea to not leave me now. He told me later he thought he was going to lose a finger.

The anesthesiologist told us they were about to deliver our baby. "Do you want to take a picture?" Hubbins had my phone for such a time as this and stood up to see over the privacy/trauma prevention screen.

First breaths
I felt movement in my lower half, but nothing more distinct than a commotion. I couldn't picture what was happening (mercifully) but knew my whole body was moving. Baby was whisked across the room to check his vitals. I heard one little cry, saw pink skin, and my tears flowed. Hubbins cut baby's umbilical cord and watched as the doctors cleaned him and evaluated his lungs (big breaths on his own!) and heart rate (strong!). Time of delivery: 5:58am. Size: 3 lbs, 15 oz.

On the way our of the operating room, Hubbins held baby near my head so I could see him up close and give his tiny face a kiss. His cheek was indescribably soft, like the baby bunnies I raised as a kid. I whimpered through my tears, "Oh, he's so cute!" ("You made funny noises that sounded like a kitten," I was informed later). Then both my boys were gone, relocating for a full evaluation and monitoring.

The doctors and nurses were still working on piecing me back together. All I could visualize was them wringing giant bath towels, as if repairing my abdomen required wrestling with massive sheets of skin. "They're stitching you now," the anesthesiologist told me. I offered across the tarp, "I quilt in my free time, so let me know if you need any help with the needlework." They chuckled and I grinned at my own joke, feeling hilarious (combination of anxiety, adrenaline and industrial strength muscle relaxants, I suppose).


I was lifted back onto my hospital bed and wheeled back to my room to recover. Suddenly, I was alone. The fog of anesthesia began to lift. I closed my eyes in an effort to sleep, but if felt like I was on The Zipper, that carnival ride I was too afraid to try as a kid. I opened my eyes again, sure I was levitating and about to topple over, and tried to adjust my body weight. In doing so, my right hand brushed against something soft but solid: there was give when my fingers pressed, but the object as a whole didn't budge. In a split second, I realized I was touching my own leg. My hand was on the cool flesh of my thigh, still numbed beyond recognition. I quickly covered myself with the flimsy hospital gown. Disconcerting.

Hubbins checked on me later in the day, and updated me on baby's progress ("He has his own room in the NICU and the doctor said he's breathing room air, no need for oxygen. His nurse likes him"). He also entertained visiting family without me, at my request to NOT be included. I was in no mood for visitors. After several hours of rest time, my day shift nurse provided me with a small snack (saltines and Jell-O never tasted so decadent).

With a renewed sense of benevolence, I confided in my nurse that I couldn't wait to meet my son. She exclaimed, "You haven't seen him yet?!" I don't know what she assumed I had been doing all day, but I had most certainly not seen him since a brief moment early that morning. She announced, "Well we need to fix that!" Suddenly, her flurry of activity was directed at getting me to my son. She pulled some unknown strings to make it possible for me to see him.

I knew the NICU was in a completely different tower from Labor and Delivery, but I had no idea where he was. With the added complication of renovations being done on the hospital, the journey to the NICU was long and confusing. Boy, was I grateful for a tenacious nurse right then. She wheeled me in my hospital bed through corridors, up and down elevators, and along endless hallways (doctors and nurses who saw us coming lept out of the way and moved mobile computer stations and office chairs out of our path). We were clearly women on a mission.

Finally we arrived at a small, climate controlled room. The sign on the door said our name and "baby boy." My nurse somehow managed to fit my giant gurney-bed into the room next to a fully enclosed isolette. There he was. His tiny body was uncovered, partially hidden by a diaper that was too big for him (but barely big enough to cover the palm of my hand). He was asleep on his stomach, his tiny mouth open, with sensors stuck on his back in several places. He had an IV in his scalp. My nurse arranged for someone to bring me back to my room whenever I was ready and after introducing me to baby's nurse, she disappeared.

A few hours old
I asked as many questions as I could think of. Baby's nurse told me he was doing really well. She used that phrase I'd heard a couple of times already: "He's breathing room air!" Apparently the steroid shots back in Bellingham had worked their magic. He was so tiny, the smallest baby I had ever seen (I soon learned that many of his NICU neighbors were even smaller). His nurse described his tendency to panic when she tried to take his temperature, and advised casually that he needed to learn to self-soothe. She talked about him like they'd really spent a lot of time together and he'd confided some personal details. He already has preferences? I marveled. Sorry kid, I thought. You've already inherited your parents' anxiety and low threshold for change.

I could barely sit up on my own, so I knew I wasn't ready to hold him yet. But seeing him and hearing his nurse talk about him like an old friend filled my heart to the very top.

Hubbins and I visited together the next day, and in the support of a wheelchair, I held him. That night I did my best to capture the moment:
Tidal wave of emotion.
No way to express it yet but I'll try.
I don't know how to position him.
He feels so extremely fragile.
I don't know how brittle or flexible he is.
I'm afraid of breaking him or crushing him, because the emotion I feel is a FORCE - a powerful wreaking pressure to sob and laugh and dance and curl up into a ball.
My SON. My incision aches as I try not to cry. I don't want to startle him with sound. I wipe my running nose on the sleeve of my hospital gown, but it's thin cotton and my nose keeps running. Tears run down my cheeks. I can't believe that I'm holding this tiny being, who, just hours ago was INSIDE my body, nestled below my ribs and alongside my kidneys, surgically removed like a vital organ. Now he's his own separate unit - fragile, but somehow partially self sufficient. He'll need me to feed him and clothe him and change him - but he's breathing by himself; his heart is pumping without help; he has his own set of organs that are all miraculously running on auto pilot like mine.  
He is perfect. He is symmetrical and smooth and adorable. His hair feels like the downiest of feathers. His tiny, intricate ears are still pressed flat against his head. There are veins in his scalp I can see and his pulse throbs in his temples. His eyes are still pinched shut so tightly that I can only see the tips of one or two eyelashes. His nose is impossibly small and I can see each pore in his skin. His lips make me think of the word "rosebud" and I can see why that comparison is so common.
Needless to say, I was smitten. We both were.

Mama and son's first snuggle

Adoring Daddy
We agreed on his name: Raylan Archer.

We first heard the name Raylan while watching the show Justified, based on the Deputy US Marshall character created by Elmore Leonard. It didn't show up on any of the baby name sites we searched, and we wanted something unique. Archer was the street our first house was on and the name of our favorite pub whose owners we've befriended over the last 15 years. It fit. We were immediately in love with our boy.


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

While Raylan befriended a whole new team of nurses in the NICU, I was able to recover in a private post-partum room. The influx of babies slowed so that I was able to stay in that room for 10 days before they needed it for another momma.

So hot right now
Two days after the C-section, as the magnesium left my system and I started to return to a semi-human state, I was finally able to take a shower. However, I overestimated my ability and reassured Hubbins he should go to the cafeteria for breakfast while I luxuriated in privacy and hot water. Because I was still on a serious dose of blood pressure meds, my heart wasn't up to the task. Once I was shampooed and fully enjoying my first shower in six days, I blacked out.

All that was left of that poor shower curtain
On my way down to the tile bathroom floor I miraculously managed to pull the emergency call-a-nurse-for-help ripcord on the other side of the toilet. I regained consciousness in a drippy pile on the floor, with nurses all around me who lifted me back into bed. As they were checking me for broken bones, concussion, or damage to my still-healing incision, Hubbins came back from breakfast to a room full of people. "Oh now what?!" he asked, poorly masking his panic with humor.

I grinned sheepishly at him, and quipped "Now that Raylan's in another room, I didn't want to give up being the center of attention." It wasn't until later that evening (when Hubbins was out of the room again, this time for dinner) that I discovered a significant gash behind my left ear, presumably the result of my fall. The on-call doctor had to come in to the room and raise my bed as high as it would go to stitch up my head. The nurses and I wondered how the heck we hadn't noticed it all day.

More stitches
*************

After those first couple of days, Raylan was moved to a larger south-facing room with a beautiful waterfront view of Lake Union where he (and I) stayed for a full month. We were so well-cared for. Even though I was sleeping on a pull-out bench turned bed, I was often able to sleep through his nighttime feedings when the nurses bottle-fed him. My life became a series of three-hour increments between pumping. I held, fed, changed, and observed Raylan as much as possible. I heard the doctors reports every morning outside our room as they did their rounds and updated the whole team on his progress. So many proud Mommy moments.





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

July 7, we brought Raylan home. It was a nerve wracking drive, but we made it safe and sound. And then a brand new adventure began as a family of three.

We're outta here!

Home sweet home

Thursday, July 2, 2015

Traits of a Great Nurse: One Patient's Perspective


This post is dedicated to all the nurses at UWMC Labor and Delivery, especially Mary M, Lori, Ann, Anna, Tammy, Jane, Karen, Lila, Christine, Bekah, Nadine, Sharon, and Laurie.

______________________________________________


One good way to understand what makes an effective and empathetic nurse is to rely on their care for multiple days. Without intending to conduct such a study, I recently had an opportunity to do just that. Due to a sudden onset of severe preeclampsia with HELLP syndrome, I was rushed to the University of Washington Medical Center's Labor and Delivery six and a half weeks before my due date. Thanks to the excellent care I received, my son was born safe and sound on Saturday, June 6 at 8:58am.




I am so thankful to each nurse that I met before, during and after delivery (one for day shift and one for night shift with few repeats). I was so impressed with their consistent positivity, skill and good humor that I kept a list of traits to remember. Becoming a mother has already made me more attentive to being the best version of myself possible, starting with the example of my caregivers.


In case you were curious, here's my take on what makes a great nurse.



Bedside Manner

As the days spent in the hospital before delivery added up, I felt increasingly like a helpless and possibly crazy person. The drugs I was given messed with my head, I couldn’t get to the bathroom without help and I needed food and water brought to me in bed. It was uncomfortable to be so needy. But I was treated with nothing but respect and dignity.



All my nurses acted as if it was normal to suddenly require help to use the toilet, not shower for days and have no control over my surroundings or my appearance. Their calm and collected demeanor normalized the whole situation for me. That was comforting. Those that related to me as if everything was in order (bantering, cracking jokes, laughing along with my interactions with Hubbins) were my favorites. It didn't seem impossible to imagine being friends in another context.

 

Approachable
All my nurses were down to earth and very easy to talk to. None of them made me feel like an imposition. As far as I knew, I was the only patient in the entire hospital: every shift change, I was the primary focus. It helped me to understand what was going on when I overheard each nurse give their replacement a synopsis of the last 12 hours of my care.
 


By day two, I was overwhelmed by so many new faces (especially when shift assignments changed mid-day). A new nurse meant another personality to learn and communication style to adapt to. But as time went on I got to know so many fun women. It became a source of entertainment to meet the next nurse! I don't know if their confidence and joie de vivre came as easily as they made it seem, but both were effective methods for putting me at ease.


Organization

The nurses who tidied my room throughout their shift made me feel the most cared-for. They took unnecessary items out of the room (empty food containers, used linens, medical equipment that was no longer needed) and cleaned all surfaces of clutter. Then they focused on what I needed without distraction. 


“Can I bring your another cold pack?” Yes, please! 

“Refill your ice water?” Yes, please! 

“Do you need another pillow?” Yes, please!




There are several nurses in my life. I don't know why I didn't make this connection before, between close control of environment and professional necessity. Of COURSE nurses like clean work spaces and carefully monitored surroundings - they are assigned  new patients and rooms constantly, they perform medical procedures that require cleanliness, they are continually picking up where someone else left off and leaving something behind for another nurse (a patient, a room, or a report). I get it now. While extraneous fussing and fidgeting got on my nerves in the past, I can now see those behaviors in a brand new light: occupational efficiency. 


I have a whole new respect and admiration for nurses everywhere. Keep up the good work.