As it relates to Vocational Discernment, BC Theologian and beloved Homeboy, Fr. Michael Himes, boils it down to Three Key Questions:

  1. What am I good at?
  2. What brings me joy?
  3. What does the world need me to do?

In the intersection of these three questions lies one’s true calling. Simple, right?

I’ve visited and revisited these three questions several times throughout my personal/professional life. Certainly a whole bunch during college, as I had absolutely no direction. I couldn’t even pick one organization to ascribe to throughout and became involved in pretty much everything at some point (And despite significant effort, I certainly failed to formulate a concrete answer to the three questions, so I ultimately chose the most all-encompassing major I could think of: “Communications”. What does that even really mean?! I figured I’d figure that out later.

As luck would have it, my graduation coincided with the downturn of the economy and a shift in the professional paradigm. No longer was a college degree in any subject a guaranteed first-class ticket to the professional world—those without one found success in things like tech startups while people holding even advanced degrees, like lawyers, struggled to find employment [I thought that was a slam dunk career?!].

So I had a nebulous, non-directional degree to match my indecisive personality in a world with many recently closed doors. Naturally, I asked myself these three questions frequently. In fact, I moved home after graduation and did a bunch of job hunting for a month and then took off to Barcelona for the remainder of the summer for some soul-searching. Because, if I’m gonna be broke and unemployed, I’d rather be broke and unemployed in Barcelona than broke and unemployed in the suburbs of Atlanta! [Side note: regular mass-email correspondences during a semester in Madrid and this summer in Barcelona served to launch my interest in writing… But that’s a different story for a different day.]

That summer provided much opportunity for reflection. I went to Barcelona with a friend from Boston College, Kristin, who was likewise well-trained in the Ignatian spirituality exercises of vocational discernment. We’d walk the beaches of Sitges, picnic in Park Guell, sip espresso at Giangrossi and wander around the Gothic quarter talking about the meaning of life and our existence within it [that is—when we weren’t passing out flyers outside of a horrible British pub at the end of La Rambla with an obnoxious neon-orange “Sports Bar” sign out front for five Euros and hour PLUS a subway sandwich].

Alas, after a few months, the fruits of that previous month of pavement-pounding job hunting back home eventually produced the fruits of an opportunity to work for BBDO Atlanta on the AT&T Account. While I had my eyes set on staying abroad or living in Southern California, San Fran, NYC, Chicago or some other exciting location, it sounded like a horrible job but with a well-renowned company within a sexy industry with excellent growth potential. My goal at the time was to be paid to travel the world. Work for the world’s third largest advertising agency? That’s the ticket! So I begrudgingly moved back to the States and even more begrudgingly moved back to Atlanta and embarked on my new “glamorous” career in Advertising.

Well, with a primary responsibility of faxing 300 sheets of paper to 300 different individuals multiple times weekly [I became the self-proclaimed “Master Faxer”] for a lower salary than my high school Day Camp Counselor job and without benefits, I looked at my superiors way up the ladder from me. Even if I did out rival the competition and work my way up to the very top of the corporate ladder, was that even what I wanted? Most female Advertising Executives’ lives consisted of a 60-80 hours workweek producing orange pictures containing three to four cell phones with no more than three bullets beneath each in an attempt to convince unsuspecting consumers that they must buy things they didn’t need [AT&T’s ridiculously stringent branding rules always made me wonder why they paid an ad agency a lot of money in addition to their internal marketing department]. I certainly don’t mind the prospect of working hard and working long hours. But ultimately I knew in my heart that that’s not what I wanted to work for. Selling cell phones [or whatever consumer commodity] wasn’t “What the World Needs Me to Do”. I think it was probably the 1,000th paper cut–likely acquired well past when the normal whistle blows–that proved to be the last straw.

What I learned:

  1. What am I good at?
    1. Creative thinking and problem solving
    2. Multitasking
    3. Writing – my first blog post contributed to “The Closet”
  2. What brings me joy?
    1. Being a part of something bigger than myself
    2. Working as part of a team–when it’s functional
    3. Alternatively, what do I loathe? 9-5 jobs. Especially when they’re really 9-8 or 9 or 10 jobs… Especially when tethered to a desk. I vowed never to work those hours again. Nor at a desk, for that matter.
  3. What does the world need me to do?
    1. Errr… umm… Well, I made it a point to make sure everyone left the closet for lunch and also enjoyed baking for birthdays. So perhaps I lifted the morale at the bleak bare bottom of the Ad Agency barrel?

Now, I certainly could have found rewarding and pleasurable work within the Marketing/Advertising worlds. And I set out to find it. In fact, I went on SIXTY interviews in thirty days. Many companies brought me back several times, and I was told on multiple occasions that they would hire me in a heartbeat but for a freeze due to the economy, which still hadn’t recovered. [One such company was Pardot in its very infancy. Fast forward 5ish years and it was bought out for MUCHO money.. Damn. Another was Engauge, which also grew to success later]. I felt like I was swimming upstream against all forces. Something wasn’t right.

And as the saying goes, “when things don’t go right, go left.” So I did. I asked myself: what do I do naturally, and how can I get paid for it?

The answer I came up with was volunteering. In middle school I’d deliver Valentine’s pastries and balloons to nursing homes. In high school I woke up early on Sundays to serve breakfast at a soup kitchen, and I went on several service trips to Nicaragua. Then in College, I continued the work in Nicaragua while also helping Hurricaine Katrina victims on three separate occasions, participating in the Appalachia Volunteers program and working in Hurley Virginia. Apparently I like helping people! And it’s something I’m good at. And the world certainly needs it. That’s the intersection! But how’s a way to commoditize helping people? Nursing!

Yup. My parents had told me to become a nurse earlier in life. In fact, I vividly remember a tearful breakfast during my Junior year at Boston College when we considered switching from Communications to Nursing–a decision which would have entailed one or two extra years of [very expensive] college to complete the degree. Not only was I tired of school [well, the academic part], but also I couldn’t justify the expense on good conscience. Mostly, though, I was stubborn and wouldn’t do anything my parents told me to do at that point because clearly I knew everything [insert sarcastic font].

Fast forward a few years and many, many paper cuts, and I put my big, fat foot in my mouth. I researched professions including RN, NP, PA, and even going to medical school to become a physician. Having two bachelors’ degrees under my belt and an unchecked ego, I decided to become a Nurse Practitioner for what I presumed would be a better quality of life than both an RN and an MD, but for an advanced degree because if I were to go back to school, I felt I should earn an advanced degree. And I certainly wasn’t going to return to school for a third go-round—it was Master’s or bust. PA was an option, but a lot of programs don’t grant an actual degree, which violated my egotistical principles at the time. Also, I learned that certain laws can complicate hiring and utilizing PAs and that PAs aren’t fully recognized in all 50 states. So NP it was!

I promptly picked up work in a fantastic Italian restaurant and took prerequisite courses at GA State. And loved it. And I learned the following:

  1. What am I good at?
    1. School! I can cram and exam like a champ. Write an essay? Boom! I’ll make you laugh and cry discussing subjects as dry as healthcare policy.
  2. What brings me joy?
    1. A flexible schedule—I reveled in the random Tuesday afternoons I’d hang by the pool with pilot friends I had at that time, while the rest of the fools toiled away at their societally-driven 9-5 desk jobs.
    2. Working alone. While I also love working on teams [that don’t suck], I also like autonomy in my work. Get sh*t done efficiently and get directly rewarded for my efforts.
    3. Engaging with people. I loved the restaurant work where I was paid to make conversation with people.
  3. What does the world need me to do?
    1. Sling pasta in an Italian restaurant? Nah.
    2. Sit and learn all day? Not that either. I was eager to produce in society. The prospect of being a lifetime student felt like I was robbing from society rather than contributing to it.

Then I started Legit Nursing School at Emory. And one month later, my mom was diagnosed with esophageal cancer. And suddenly the past made sense. That force that I felt working against me getting a job in marketing? I truly think it was the work of serendipity or God or whatever Power-That-Be you believe in. Had I locked myself into a full-time job with a demanding schedule, our family would never have been able to manage the care of my mom. It became a 24/7 job that my Dad and I tag teamed to accomplish.

About nine months later, she passed away. And I completed my Bachelor’s Degree in Nursing and went on to pursue my Master’s in Nursing. But I almost wasn’t granted entry. Dian, the program director of the Emergency and Family Nurse Practitioner program [again, I chose the broadest certifications I could find, still unsure of a path] advised me that she never accepts students without prior RN experience [perhaps for good reason, I realize in hindsight]. Well, I had been accepted to the Master’s program prior to even starting my Bachelor’s. So I fought. Adamantly.

Eventually she conceded and allowed allow me and Robin Goodwin, who was also in the same position, to start–provided that we completed a Nursing Externship during our first semester of the NP program. Boom! Well, soon enough, Dian told us that we single-handedly changed her mind about NP students without RN experience. In fact, she said, the two of us were her best, most dedicated and high-achieving students. Hah! Take that!

As graduation from my Master’s approached, I again asked the three questions reflecting on my previous professional and personal experiences:

  1. What am I good at?
    1. Rapid decision-making
    2. Creative problem solving
  2. What brings me joy?
    1. Again, a nontraditional schedule
    2. Helping the most vulnerable of people
    3. A good challenge
  3. What does the world need me to do?
    1. Help people! Ideally at their most vulnerable

At this point in my life, I had developed a martyr complex on top of the pre-established ego, so I sought out the most challenging position I could find with the most vulnerable patient population. Because I was going to single-handedly revolutionize the “Mid-level Provider” role. So I accepted a position in the ER of Atlanta’s Main Level I Trauma Center. Considering I did a lot of training at that hospital, it would be a piece of cake, right?

Uh no. It was terrifying. Here I was, with a fraction of the school that a doc had, cast into the trenches to dig my way out of the corpses thrown at me. I remember being tucked away in the corner in the “Fast Track” of the ER with its six patient rooms equipped with nothing more than a cheap, plastic chair and holes in the wall where things like oto/opthalmoscopes and other important fixtures had been stripped. I remember seeing my first patient and returninig to my cubby hole to complete my note. And then… I signed it. OMG. I needed a moment to compse myself. That’s like… out there. ME. MY name. Shit. What if I was wrong? Uh, can someone call a doctor over here?!

Well, I got over it, and continued seeing patients. I also worked in the Observation Unit doing inpatient-type of work that I was ill-prepared to do. Luckily the slower pace of that area provided me the time to research what I didn’t know and/or seek help when appropriate. And I also saw patients in the “Red Zone”–the lower acuity medical area where all to often sicker patients overflowed into. And eventually I started training to work in the super-intense level I trauma area.

What I learned? Oh my goodness. Where do I even begin?!

  1. What am I good at?
    1. Thinking globally and systemically. Working within an institution with much opportunity for improvement, I constantly found myself analyzing work flow and processes to identify way to improve. I always thought to myself, there has GOT to be a better way! And then would brainstorm solutions.
    2. Conversely, what am I not good at? Memorization. There were SO MANY little things that I’d constantly have to reference that I should have easily recounted. Not a big deal equipped with a smartphone in my pocket, but a good thing to note moving forward.
    3. Communication. I received much positive feedback from my patients about my ability to explain to them complex medical information in an accessible way, and they often thanked me from taking the time to do so.
    4. Assessing true needs. In the US system, many many patients come to the ER for “Social” issues rather than medical ones. Food, shelter, mental health help. I developed a knack for asking poignant questions to determine what was the true issue for their visit. And then directing them to the appropriate resource [which often wasn’t the ER or hospital at all].
  2. What brings me joy?
    1. Making a difference in peoples’ lives. In the ER, you see people at their absolute weakest moments. Brought in when they’re in dire straights. Even those “frequent flyers” with social issues needed attention, and, in most cases, I was happy to provide them with whatever help I could offer.
    2. Well, what doesn’t bring me joy is working at night. Especially when the expectations and demands for not just quality of care [which of course, should never be lowered] but also for productivity are the same as the day time, I loathed working nights. And my body hated it more. I nearly crashed my car driving home the morning after a nightshift on a handful of occasions, which is more frightening considering my commute was a mere three miles long. I questioned my ability to make decisions, and legitimately feared making a fatal mistake in the fog of sleep deprivation.
    3. Maintaining consistent relationships with family, friends and coworkers. The erratic schedule of the ER impaired my ability to maintain contact with “normal people”. Sure, it was the nontraditional schedule that I sought, but I noticed myself becoming detached and lonely.
    4. Procedures. I really enjoyed doing things like suturing and popping gargantuan abscises and pulling lodged bullets out of people feet [I did that twice in six months]. This lowered my patient volume, which was unfortunately punished rather than rewarded in that system.
    5. Triathlon!! It was prior to starting this job that I started dabbling in endurance sports. It gradually acquired importance during this period of time, and I became frustrated with a schedule that was uber-non-conducive to training.
  3. What does the world need me to do?
    1. Help the vulnerable! I certainly fulfilled a huge need in society during this role.
    2. Know shit. I remained terrified of what I didn’t know that I didn’t know. Unlike a doctor, I hadn’t been trained in identifying the “zebras” of medicine.
    3. Compete in triathlon? I developed a knack for the sport. I started brainstorming how I could leverage the sport to help people. Because people typically don’t just sign up for something like an Ironman–they’re usually some underlying wound or other motivation to address.

The erratic schedule with demands impossible to fulfill in a role that I felt was over my head inspired me to look outside the walls of the ECC. Add to that an increasing inability to work at nighttime [I expected to get better, but gradually felt worse] with a legitimate fear of making a mistake, particularly within the context of certain triage/workflow issues that coerced me into seeing patients with higher levels of acuity than I was comfortable with. And I knew I needed a change rapidly. As added motivation, I learned about the importance of consistency, sleep and good habits in endurance sports, so I sought those out.

That ego of mine was quickly deflated during clinical rotations in NP school. During my job in the ECC, my spirit was demolished, and I acquired a deep-rooted inferiority complex–one which plagues me to this day.

Now, had I dropped to part-time, I probably would have eliminated a lot of the issues and genuinely enjoyed the role. But that wasn’t an option financially.

So. I had an opportunity to join the Nurse Practitioner-run Heart Failure Service at that same hospital. The benefits of this role included a dream schedule consisting of 4×10-hour shifts M-F without holidays!! The idea of specializing and becoming an expert appealed to me [and I still firmly believe is the best way to incorporate Mid-Level providers into the US system]. Also, the team of just three NPs seemed to grant the opportunity to advance–or, at minimum, to positively influence the operations and make a difference at a systemic level.

This move certainly improved my quality of life. I slept at nighttime–I can’t tell you how amazing that one change was! I quickly became an expert in the area [well, aside from advanced therapies, which our hospital referred out], which felt awesome. Residents and nurses and even Attendings asked me questions about how to properly manage patients. I no longer finished each day feeling like an absolute moron [only some days ha!].

The role specifically worked with high risk, “frequent fliers” to help keep them out of the hospital for thirty days at a time to avoid Medicare penalties. The specifics merit a separate post, but I became intricately involved in not only the ins and outs of the Medicare system but also Medicaid, the hospital system and many other social systems. Additionally, I became intimately involved in the lives of my patients. Some of them called me daily. I followed them closely and got to know them as people–and their care givers and social workers and families, etc. Rather than watch people die quickly in the ER, I watched people die slowly. And it was highly rewarding a lot of the time. But it was also insanely draining. And while I learned about the good in people, I also was subject to a whole lot of verbal and emotional abuse from others.

Over time, I became highly disillusioned with the US healthcare and social system as well as with humanity at large–again, a subject to elaborate on at a different time.

Again, I learned a whole lot.

  1. What am I good at?
    1. Educating–the role entailed a whole lot of education. I found myself able to get my patients [with an average reading level of 2nd grade] to understand the highly complex pathophysiology of Heart Failure, as well as the highly involved lifestyle and medication regimens. Several cardiologists would note that–after seeing me–their patients would explain to them their disease, medications and why they needed to take them.
    2. Persuasion. This role tapped into my prior advertising/marketing/communications knowledge. To get a patient to take 10 different medications daily, restrict their fluid intake and follow a strict low-sodium diet required a whole lot of convincing. I actively utilized a lot of tactics I’d learned prior to my nursing days.
    3. Analyzing systems–here even more than the ER did I notice areas for improvement particularly as it related to work flow and optimizing resources. I also noticed this within the US healthcare system. Unfortunately, I realized there was absolutely no way an individual like myself would have any sort of impact, which was quite demoralizing to me. I couldn’t even impact the tiny HF department, chained by the bureaucratic hospital system.
  2. What brings me joy?
    1. Helping people! I truly loved certain patients and loved the work of going the extra mile for them.
    2. Conversely, what brings me hatred? A system in which the terrible, horrible people of society receive all of the benefits while those that actually need it and/or actually try to help themselves are punished.
    3. Day-to-day variety. I enjoyed the fact that this position floated both inpatient and outpatient, and I had some level of control over my schedule. I did not like having a clinic schedule, though. A greater degree of control would have been more satisfying.
  3. What does the world need me to do?
    1. Help people! Duh. This was reinforced.
    2. Help improve processes and systems. If it would just allow me to do it.
    3. Help people who want to help themselves. I found it very challenging to work with a lot of people who literally couldn’t care less if they lived or died.

Again, had I performed this job on a part-time basis, I’d probably still be there. But I found my soul leaking out of my being. I poured a whole lot of emotion into my patients, and relationships with family, friends and significant others consequently suffered. And my martyr complex rapidly diminished. Why can’t I just have an easy job that makes lots of money and enables me to have a good life? What’s wrong with that?! I also gained exposure to triathlon friends with super cushy, very highly lucrative jobs. Perhaps there’s a better life out there?

Meanwhile, I had been doing a projects on the side for a sports nutrition supplements company in its very infancy. I revamped the copy of marketing materials, blogged, helped with the sales pitch and contributed to product development initiatives. And really loved it! It tapped into my creative side that had laid dormant. The workday was excitingly variable and I had the bonus of controlling it. When the opportunity arose to manage the race team of 450 athletes and move to Boulder, I jumped on the opportunity. I got my ducks in a row financially and logistically and made a leap of faith and a move across the country.

Fast forward to the onset of the Existential Opportunity and I, again, try to make sense of it all. So, again I ask myself the three key questions over and over and over again. While I previously had divided my job search into three principle areas: 1) Marketing/sales positions in the sports-related world 2) Sales/Clinical Nurse Educator roles in the pharma/device industries and 3) straight-up NP positions, I can’t help but harp on that third question: What does the World need me to do?

And although being an NP didn’t pan out to be what I thought it would, I can’t help but feel the need to contribute to society in this role. I’ve made huge sacrifices to earn an advanced degree in Nursing and to gain experience. There is an overwhelming need for the skills I’ve gained–can I really let those go to waste and build a career selling t-shirts or some drug? I feel like if I did, I’d look back in five and ten years with regret and/or guilt.

The work is hard. It’s emotionally draining. It’s poorly rewarded both financially and non financially. The demands are often unfulfillable. But I feel like I must do it–at least in some capacity. So I’m now focusing most of my energies on part-time NP jobs to work 24-30 hours a week. Hopefully that way the role will be sustainable for me while productively contributing to the betterment of humanity and enabling me spare time to dabble in other endeavors.

And I interviewed for a position a few days ago that seems to actually provide a decent quality of life for its NPs. Soooo we’ll see…