The Day the Writing Died

Once upon a time, when blogging was still in its infancy, the names and faces of the authors were hidden. Anonymity was important because blogs were treated as online diaries. Sometimes they were confessionals, many times they were gritty insights into the souls of individuals we became anonymous friends with. At times, through clunky comment sections and even email, friendships were struck up over common experiences or beliefs.

I remember finally deciding to “come out” of the blogging closet to management where I worked as a flight nurse. The job is still, by far, the sexiest of the healthcare world. People were interested. My readership had grown and more of my coworkers knew about my writing. It goes without saying that being a flight nurse at a busy company was physically and emotionally risky. One of my peers once said that, “you haven’t made it until Emily writes about you on her blog.”

The words were my therapy, my art. I told stories of what it was like from my perspective, from my soul. I skated the very edge of HIPAA during a time in which its very definition was evolving.

Then we crashed.

I was there that day.

My sister, an operating room nurse nine floors below the helipad, felt the building shake. She heard the alarms, then someone rushed into her room declaring that it was a crash and all 4 people were dead.

So there she was, scrubbed into a case, believing I was dead.

In my heart I know that, during the routine FAA check ride that ended with the crash, there were no fatalities because of the pilot’s experience and intensive training. The training, an unusually high standard across the industry due to the high cost, saved both of the pilots were were on board. Our institution handled it with professionalism and instead of hammers being thrown and blame being the course of crisis management, good things happened. It was proof that training saves lives. In this case, potentially hundreds. It also led to millions of dollars invested to improve infrastructure.

Unfortunately, the toll it took on the staff was something less able to be quantified or fixed. Lives were changed. My life changed. It was the day I decided that my marriage wouldn’t last. Some people quit. Some never flew again.

As we watched the helicopter burn on CNN it was the day my writing died.

My sister and I have never been much for lots of outward signs of affection. It has always just been an unspoken, mutual understanding that we were each other’s rock.

I held it together until she pulled into the parking lot of the hangar. Never have I been more relieved to see someone. Never have I had a truer embrace.

She whispered, “I just needed to see you.”

As told by the Author

Stop Counting Cars

The only person in this world you have 100% control over is yourself.

the Wisdom of Beama

In order to sustain some semblance of sanity while strictly following a self-imposed, social distance, I settled on a stroll.

Ok, I went for a fucking walk.

When the outbreak began creeping toward West Michigan, I made the conscious decision that once we began caring for COVID-19 positive patients, I would go no further than home and back to the hospital where I work. Daily walks, setting limits on the consumption of digital media and creating to do lists were part of my self care.

The daily walk consisted of a one mile stretch along a main route in and out town and on one particularly sunny day I decided to count cars, simply out of curiosity. During that easy 18 minute mile, 131 vehicles drove past me.

And it pissed me off.

When the count started, I guesstimated 60 cars in that 18 minutes. I tried to stop my brain from continuing to tally as the number approached 75, then 100, but couldn’t. My stomach began to hurt and my thoughts began to tumble.

Where in the hell did 131 people need to go? Didn’t they know we were told to stay home? What was so important that they needed to expose themselves to this horrible virus AND DON’T THEY KNOW THERE AREN’T ENOUGH PEOPLE OR ROOMS OR EQUIPMENT TO PROPERLY TAKE CARE OF THEM WHEN THEY GET SICK BECAUSE THEY WERE STUPID?

There was a moment of relief as my feet found their way back onto my road and I forced myself to stop counting. The last half mile home the podcast episode piped into my earbuds retreated into background blather. I repeatedly asked myself why that number pissed me off.

It was control. I had no control over the train wreck I was envisioning myself and my colleagues facing. That goddamn curve wasn’t going to flatten if those people driving around kept flipping science the bird. We as, healthcare providers, were the ones expected to deal with the aftermath.

But I control me.

Over the years, when discussing the concerning actions of a friend or loved one, my Mother reminded me that the only person I have control over is myself. Even when witnessing someone we love doing something harmful, we can only express our concern and then let it be, simply removing ourselves from the situation if necessary. It is not our place to do more than that and continuing to nag, badger or guilt someone only leads to strife, anxiety, anger and damaged relationships.

131

It is my choice to follow the science and my decision to stay home and safe. I possess autonomy and sanity and ability to consciously choose to do the right thing.

And so, through writing this, I remind myself of what mom taught me and tell myself again: Stop counting cars.

You Learn By Living

One thing life has taught me: if you are interested, you never have to look for new interests. They come to you. … All you need to do is to be curious, receptive, eager for experience. And there’s one strange thing: when you are genuinely interested in one thing, it will always lead to something else.

You Learn by Living—Eleanore Roosevelt

I often times imagining myself as the Disney version of Alice, tumbling down the rabbit hole but without finding bottom. As each random item or book smacks against my fall, it changes my course of descent, careening my brain against another knowledge heavy compendium.

For me, curiosity is integral to my intellect. It was once described as ADOBSO (Attention Deficit, OH! Bright Shiny Object) but instead of viewing my diverse interests as a personal flaw, I’ve come to embrace my shifting interests as an asset. Once, a nurse quietly listened to the banter between myself and a patient. She brought the conversation up a few hours later, expressing surprise at my consistent ability to find common interests with strangers.

Instead of becoming an ‘expert’ at one thing, is it possible to obtain legitimate expertise at learning many things?

Something to contemplate.

Resurrection

I started my first blog today, 12 November, in 2003. For those of you who suck at math, that is 16 years ago. 16 fucking years ago. That was back before blogging was really a thing, and authors, many times, published anonymously. Even with being hacked, two marriages, moving halfway across the country, I saved this. All 670+ posts. Through “coming out” as a blogger. Through a helicopter crash that sucked the life out of my writing (no, I wasn’t on board but my family thought I was dead—a long story). Through telling Uncle Sam to pound sand. Through telling my biggest professional dream that we needed a divorce. Through therapy, through medication, through all kinds of shit. I couldn’t let this small digital file go. Once upon a time I was even offered $5K for the domain. It was too much of me.

My identity.

So here it sat. Collecting digital dust. As I’ve learned, all good things happen when they are supposed to, not when my impatient, impertinent ass wants them to.

Today. Today was the day where my voice returned.

There is a really annoying saying:

…dance like no one is watching.

Once upon a time, I wrote like no one was watching. I think it is time to do just that . . . again.

Tell Me About Flight Nursing

I was asked to assist a nursing student with a project in which he needed to explore a specific type of nursing of his choice. I was honored and excited that he chose flight nursing. Below is my answer to him and thought it would be a good overview for anyone thinking about becoming a flight nurse as well.

My official name/title is:

Emily J. Bennett, MSN, RN, APRN-BC, CFRN, CEN, CCRN, NREMT-P

(Nursing and its continued plague of credentials for “credibility” makes me insane, but it is the game we play)

I am educated as an Adult Acute Care Nurse Practitioner, I have nursing certifications in flight, emergency and critical care and am also a paramedic.

To fly with us, very little of that is actually required. As our hospital makes it a priority to have a BSN, we usually start with that, but we have nurses educated at the Associates level and most have the intent to finish their BSN. In addition to being an RN, you must also be licensed as a paramedic due to the requirement in the state of Michigan that all advanced life support “ambulances” have a medic onboard. This combination of RN and Medic is very difficult to find. Beyond the typical licensing, on a whole, experience is usually much more important to us. We look for someone who has 4+ years minimum experience in a busy ED/ICU. Any street time as a paramedic is a huge bonus. It doesn’t matter if it is Peds ICU or Adult ICU, simply that there is ICU experience. ED experience at a level one trauma center is best.

Other credentials we look for before hiring but at a minimum are required after starting are:

BLS–basic CPR
ACLS–Advanced Cardiac Life Support
PALS–Pediatric Advanced Life Support
NRP–Neonatal Resuscitation Provider
ATCN or TNCC–Advanced Trauma Care for Nurses or Trauma Nurse Core Course
ITLS or PHTLS–International Trauma Life Support or Pre-Hospital Trauma Life Support

We also require speciality nursing certification (CFRN) or one of the others related to flight nursing within 2 years of hire.

There is a huge personality requirement for the job as well. You must be loyal to the team and willing to do what needs to be done in order to learn, keep your team safe and pitch in when needed—even if it means sacrificing time with your family. We are close knit and need to be so because there are only a few nurses trained to cover 36 hours a day. It isn’t like we have the ability to just ask for a nurse from another floor to come take a patient load. We operate in an environment that is the equivalent to providing patient care in the something the size of a closet on its side, many times in the dark with only 4 hands and without your sense of hearing. It can be overwhelming, intense, and many times, emotionally difficult.

You have to be confident without being an arrogant prick as well. By wearing a flight suit, we take responsibility when no one else wants it. That is what is expected of us when we land at a scene or show up at a hospital. If we start to panic or can’t function, even if it takes us awhile to figure out what needs done, it can (without meaning to be too dramatic) kill someone or your team.

Ok, enough with the dramatic…..

We work 12 hour shifts (7a-7p, 10a-10p, 7p-7a). Unfortunately, it isn’t uncommon for us to get a a late flight stretching that work day from 12 top 14+ hours. If you get a call right before you are supposed to leave and your relief isn’t there, you take it. When I get home late, it is never much of a surprise as it is part of the job.

During a normal shift we arrive about 15 minutes before and get report from the off-going nurse. We brief with the entire crew, our dispatcher and someone from maintenance. During that time, we discuss weather, what is going on with the aircraft, any medical equipment issues, etc. After briefing, the crew checks the aircraft. The pilots do a pre-flight, the medical crew (2 nurses or a board certified ER physician and a nurse) checks all the medical equipment against a checklist to ensure it is there and functioning. After that we essential sit and wait for a call. We each have an office and always have other projects to work on so time isn’t wasted.

A typical call begins with the dispatcher (flight communicator) being contacted by a hospital or an EMS agency. We are notified over our radios that we have a flight and the pilot makes the decision if we can go based on the weather. Once we are cleared for weather, one medical team member gets the information for the flight, while the other packs the blood (we carry 4 units of PRBCs) and grabs the laptop. The pilot pushed the helicopter out onto the ramp and we launch.

During the flight, the medical crew preps what we can for the call. This may be looking up diagnosis/drug information on our iPad, starting the chart, or rearranging equipment. Depending on how critical the call is, or how frequently the crew works together, we may also verbally plan our roles for the call and our patient care.

After getting to the patient, packaging them for transport and making whatever phone calls we need to, we take them back to the aircraft. This sounds simple, but keep in mind that we have the capability to do everything from advanced airway management and ventilator support to emergency child birth to balloon pump transfers. Some calls may take up to 5+ hours depending on how critical or far away someone is.

The logistics of patient transport is probably the most interesting component of what we do. Don’t get me wrong, the intubations, chest tubes and flying are all sexy, but getting the patient from point a to point b dealing with everything from weather, to hospital bed availability to specialist unit/physician availability is very challenging. I can tell you crazy logistics stories like taking a patient straight to the OR in the wee hours on a Sunday morning so a cardio-thoracic surgeon could emergently crack a chest to patch a hole in a ventricle. That type of call requires mobilizing about 5 departments, 40+ people, a helicopter and all during abnormal hours. Successful coordination like this happens because our flight communicators are incredible. For a normal flight they take or make 35+ phone calls. For one like that, I would guesstimate upwards of 50. Fortunately, not all of our calls are that difficult or intense, but the moment we let our guard down or become complacent is when we fail.

When asked advice for becoming a flight nurse I usually suggest patience, tenacity and focus on the goal of flying. Flight nurse positions are rare, but luck favors the prepared mind. I’ve seen people who want to fly, and look good, but do nothing to prove they want it. Those who succeed, are aggressive at growing in the nursing profession by obtaining as many of the classes or certifications possible and taking opportunities to work in different areas. The successful flight nurses are the ones who learn to function in areas where they aren’t necessarily comfortable, don’t know everyone or where everything is but give great care anyways.

The 10 Responsibilities of the Long Form Blogger

During my time with Mike and Sean, two icons in the medical and nursing blogospheres, I began thinking about why being a long form blogger is so difficult to maintain overtime and why it is running the risk of becoming obsolete.  The three of us have all struggled with social media burnout and have scaled back, or in my case, have disappeared from social media all together.  We even tossed around the following question:

Is long the long form blog dying?

Yes, dear reader, I believe it is.  But why?  Where did it go?  Where is the love?

1.  Writing is difficult:  Blog posts of substance require a lot of thought, some editing and should be an interesting topic.  The point of writing, after all, is to be read.  At times, the words flow like water over a cliff.  They run through the keyboard.  Other times, they have to be dug from the recesses of your mind.  The successful blogger, and writer, knows the true meaning of writer’s block but will find a way through it.

2.  A blog is a website that needs maintained:  Let’s face it.  Most bloggers are complete nerds when it comes to their blog.  They update not just the posts, but ensure their readers are able to share with embedded links to other social media sites, they link to other blogs in their sidebars, and ensure the layout and look of the blog are a reflection of who they are and what they write about.  This doesn’t even cover the time needed to clean out and protect the site from spam comments and continually update the blog software, and the apps needed to successfully capture ideas, photos, videos and words.

3.  Information can drown you:  My first online journal was created in 1999 when the term blog didn’t exist yet.  Since then, I have had too many social media accounts to remember and now keep up with other blogs through RSS feeds, Twitter, Facebook, Pinterest . . . the list sometimes seems endless.  Finding a way to manage the interesting information is in itself an overwhelming task.  Unfortunately, saving the writing and ideas of others to be read more indepthly later may end up being the breaking point.  How often is it possible to go back and reread all of those links?  Unless you, as a blogger, are diligent, consistant, and dedicated the sheer amount of information may become too much to handle.  This leads to the quick reTweet of links and Sharing on Facebook with little to no substance behind what you found important enough to share.

4.  Life is busy:  Life is damn busy.  You have to really want to be a true, old school blogger.

5.  Success relys on relationship cultivation:  Online relationships come from discussion, comments and participation.  So, looking at the previous four, where this fit into your time hack???

6.  ADOBSO:  Attention Deficit—Oh! Bright Shiny Object!  If you aren’t focused, writing long form, especially when attempting to link to other sites and add multimedia, you can get lost in the Internet and eventually forget what you set out to do in the first place!

7.  Evidence based concepts are intimidating:  When writing about health care, especially when dealing with clinical subjects, it is easy to get overwhelmed with the idea that everything must be written like a term paper and annotated.  This has ground many a blogger’s writing to a halt.

8.  Your blog never goes away:  The constant reminder by the MSM (main stream media) and your employer that everything you put on the Internet is permanent is down right frightening.  This thought process is every bit as scary and even more so for the bloggers who have been around for awhile.  As a person gets older, as social media evolves and as professional lives advance, what was ok 10 years ago may not continue to be ok.

9.  ADOBSO:  Heh, yeah—–Squirrel!

10.  Blogging is a huge responsibility:

–Regular updates are an integral part of remaining part of the conversation and cultivating readership.

–Employers usually have a say in what you write and how you represent yourself requiring self-censorship which may become dangerous to your professional life if not adhered to.

–You must be prepared to become an unintentional mentor and cultivate relationships IRL (in real life).

As I go on to define who I am as a blogger today, versus who I was as a blogger almost 10 years ago, it becomes obvious where my personal shortcomings in writing originate from.  Many of my challanges are based on my current professional role.  It is difficult to know when you are crossing the line when that line is faint or if the line is moving.  I am one of the fortunate bloggers.  My employer is progressive in their social media outlook.  Unfortunately, my niche in flight medicine makes me extremely visible in that writing about specific experiences is almost impossible when the local media covers the story first (and usually gets it wrong btw).

When I first began blogging, I wasn’t prepared to be a mentor and didn’t understand how important it is to maintain and answer the emails I received because of my blog.  Quite frankly, I sucked at it.  It became so overwhelming I didn’t keep up and for those you sent me email or commented in the past, I apologize.  This bothers me more than just about anything related to my online life.  I squandered the relationships that could have been with professionals around the globe.

Now that I spent time away, broke the cycle of living life so I can blog about it versus blogging because I am living life, I feel more prepared to be that long form blogger.  I am still working on blowing away the chafe and finding an optimal mental process for writing but am more comfortable in my head knowing that being a long form blogger is truly a difficult role to take on.

EMI Testing for use in Flight

No Shit, There I was

L-R Sean (@iamunafraid), Emily (@crzegrl15) & Mike (@drmikesevilla)

When I was in the Army, the best stories began with:

 “No shit, there I was . . .”

When that slid off of a soldier’s tongue, you knew you were in for a whopper.  The story, if told by a FNG (f’ing new guy), was usually one of boasting and exaggeration, which no one was expected to believe.  We would listen anyways out of simulated respect and only groan when it was the 5th time or the 100th time we heard the same old thing.  If, however, an old crusty sergeant uttered the same statement—the type personified in old John Wayne movies, we knew to sit down, shut up, and hang on for the ride was going to be a good one.

No shit.  There I was . . . in Cleveland at a bar in the she-she Ritz Carlton, paying too much for my dirty Belvedere, on the rocks with a string of olives.

And so it began.  The evening of one long conversation of serious revelations broken by stare inducing laughter.

And the three friends finally met.  Conversation without the aid of a video camera or a keyboard.  No Internet required.

And @iamunafraid, @drmikesevilla & @crzegrl15 became Sean, Mike and Emily.

Mike captured the evening with a blog post that night (or early the next morning as it were).

Sean wrote the next day and then went on to write a blog post in the true long form capturing the nature of what old school bloggin’ is all about, in over 3,000 words.

Me?  I’ve taken the slow but sure path to relating my evening of epiphanies.  It has officially been nine days and Sean won’t leave me alone until I post.  So, this is going to be a bit fragmented.  A version of diarrhea of the fingers . . .

What is so gripping that this story should begin with “no shit, there I was?”  For you, maybe nothing.  For me, the conversation and ideas helped to shape the world of things to come for me and social media.  I have stated over and over throughout the past 4 or so years that I would blog more or be more involved.  By talking out loud that night with Mike and Sean, I realized that my not being true to my word was a result of many different circumstances both professionally and personally, but also involved the evolution of social media.

Originally when we old-timers began blogging, it was anonymously or semi-anonymously.  We hid in the blogging closet where it was safe and quiet.  Then the social media world became one in which the whole world was involved and the art form of the long blog post was reduced to the abbreviations and hashtags of Twitter.  During the evening we discussed the ugliness of what we have become as an online society and how mentally devastating it is for those who began before Twitter and Facebook existed.

We came to term this as “Get off My Lawn!” Syndrome.  Mike described it as feeling like the crabby old guy who sits on his porch and yells “GET OFF MY LAWN” at anyone who ventures onto his property.  In short, we old bloggers feel like the old crotchety elderly neighbors who do nothing but complain and yell at the neighbor kids.  But, after us old heads finished spending time longing for the old days of the Internet, we began to progress the conversation to the good that has come of it.  For me, it is the exciting world of #FOAMed (Free Open Access Meducation) and the subset of FOAMed that includes Retrieval (aka Transport) Medicine.  For Sean, it is a love for the student and new RNs.  For Mike, it is the Family Medicine Revolution.

We determined that blogging and social media is becoming subspecialized.  It used to be that you blogged about your personal life and the many things you were interested in but the stories were personal.  I named my blog “Crzegrl” because it was a nickname that personified me.  As time has gone on, blogs created by individuals became topic focused and much social media presence is now based on that particular topic.  You know, “Hello I am Emily and I blog and converse about X.”  Throughout the discussion we concluded that this is the new future of the world we love and have helped shape.  So, over my third Yuengling of the evening, I re-raised the idea which I had attempted about 18 months ago.  

Should I do away with my blog crzegrl.net and become something related to transport medicine?  

There wasn’t hesitation in Sean and Mike’s response:  both of their heads snapped up and they almost shouted “no” in unison.

I didn’t realize how much of a “brand” or person I had become online.  To lose crzegrl would absolutely be to lose part of myself, but it took their opinions to make me understand who I had become to others as well.  

So, No shit, there I was . . . in Cleveland to meet two strangers who really weren’t strangers.  I began with dirty Belvedere on the rocks with a string of olives and finished with Yuengling.  I started with a confused sense of who the Social Media Emily is and ended with an undefined but percolating sense of who I was to become.  My previous blogging success was based on brutally honesty.  It was based on not being afraid to talk about the difficult and the painful.  

I am Emily Bennett.  I am a flight nurse, and a life long adventurer.  I am one who cringes at the thought of conventional professionalism and is passionate about being the best—because why devote time unless you are fully committed to giving that one thing you can never get back? I love to be a bit of everything and know a little about a lot.  I am passionate about skydiving, my friends, my family and my writing.  I am in love with resuscitation and transport medicine.  

Do not tell me a day exists where I will no longer fly with the birds or swim with the fish.

Return of the Girl

So, I took an unscheduled sabbatical.  Yup.  And it was one of the best things I have ever done.  After years of blogging and growing up with social media I was told by my spouse, “Not everything is Facebook worthy.”  His simple statement led me to a social media blackout that included deleting (but archiving) my blog, my Twitter account (@crzegrl15) and my Facebook account.  I couldn’t believe how much social media was weaved into the way I approached everything in my life.  There was a quite voice that was ever present:

Emily, you should blog about that . . . Emily, this photo would be great on Twitter . . . Emily check Facebook AGAIN.

I recognized I had a problem.  The motivation I had for doing something was simply because I could post about it.  I wasn’t living life and then realizing I might post something interesting.

Eventually, the cobbled on mess of my social media presence became overwhelming.  The large number of followers, the emails I just couldn’t get to and the cluttered, cobbled together file system looked like the digital version of something out of the TV show “Hoarders.”

So, I did what we all have wanted to do with the messes we are confronted with.  I proceeded to commence the digital version of lighting a match.  Then I really lit a match.  And created a giant bonfire last summer to start over.  I burned my past.  Photos, journals, memorabilia—almost everything.  Everything except the things that were Facebook worthy.  The moments in my life of which I am most proud.

After removing the digital, mental and physical clutter, I began to swim again.  And bike.  I got rid of financial clutter.  Had a few surgeries I was putting off while in search of the non-existent “perfect time.”  I began yoga one on one with a mentor.  I canceled all of my credit cards.  I  saw a counselor.  I cleared the physical, emotional and financial baggage.

Then, I realized I was ready for my friends.  I needed my friends.  I was ready to be a better friend.  One that they deserved.  I opened my Facebook account and had instantaneous responses that have just kept coming.  I opened my Twitter account and my old friends were there to welcome me back with open arms.

Ah, Twitter.  How I have missed thee?  Let me count the ways.

@iamunafraid @drmikesevilla @nursekeith —This is for you.  Thank you from the bottom of my heart for the encouragement to return.

Summer Drought

All things happen in cycles. Unfortunately, I am currently in the “White Cloud” part of my work cycle. That means, dear readers, that I have been the anti-flight nurse. Ground response via mini-van? Yeah, have done 3. My last patient flight was almost a month ago. Blame it on bad luck. Blame it on the weather.

I will blame it on the EMS gods.

I should go sacrifice a pilot or two. Maybe that would change my luck.

*ducks flying helmets*

Flight Nurse’s Hierarchy of Needs

I can tell how much time I have spent at the hangar by how unorganized my life becomes.

It is all I can do to ensure the laundry is done, there is food in the fridge and my truck is not trashed. In the past, one by one, these things gradually get out of control. I would finally have a day off and the awful state of my world would come into focus.

We recently have found ourselves sorely short staffed. As with any healthcare department, it is cyclical and not surprising. This, however, has been more challenging than normal.

When discussing flight medicine with someone seriously considering it as a career, I try to mention some of the more unique features of the field. This is not like working for an ambulance company or a med/surg floor with a huge pool of part time employees. There is no being pulled to the helicopter like they used to pull me to the floor when they were short staffed.

There are a set number of full-time flight nurses who cover 36 hours a day 7 days a week 365 days a year. There is no calling out sick because of a hang-over or wanting to screw off when the weather is nice. We work when we don’t necessarily feel well. We give up family functions, vacations and planned days off frequently to ensure there is coverage.

We have no resource pool. We are it.

It may be our family that needs us. It may be our friend or neighbor who is ill or injured. We possess a dedication to our profession, our patients and ourselves that far surpasses the usual work place. Even when we don’t know how things will work out, we cover the shifts. Some way, somehow.

Flexible to the point of liquidation but not vaporization.

I am never more impressed with my peers than when the proverbial shit seems to be hitting the fan. I am proud to be one of them.