Trauma ICU Nurse and Travel Host, Myra Gamble

[00:00] Michelle: Myra Gamble is so chill and laid back, it's hard to believe she's a trauma ICU nurse. She's also done emergency room nursing, hospice, home health, cath lab, interventional radiology and telemetry. And I imagine that such a wide range of experience has only made her a better ICU nurse. As I listened to her recount stories from the COVID ICU, I remembered the toll it took on so many healthcare professionals. I loved hearing how she organizes her day (she may have a touch of OCD) and how it's vital in a busy ICU to have appropriate ratios and break nurses. We talked about what it means to be part of a tribe, and for Myra, the deep connections she has with her coworkers have certainly enriched her life. She's now enriching others through her business, Travel with a Tribe, LLC. Myra helps travelers find joy in experiencing new places, cultures, people, and food, don't forget the food. She makes it so easy, all you have to do is show up. And what could be more alluring to busy medical professionals than to have everything done for you? Maybe more PTO. Yeah, definitely more PTO. Myra's philosophy is life is too short to not use your PTO. So get off the couch, get on a plane, and see the world! In the five-minute snippet: Food, don't forget the food.
Well, good morning, Myra. Welcome to the program.
[02:08] Myra: Oh, good morning, and thanks for having me.
[02:11] Michelle: Well, you're welcome. We met on Instagram, so I think you came across my feed and I was like, oh, what is this? And I checked out your page. And that's Traveling with Myra on your Instagram, right?
[02:30] Myra: Correct. Yes, it is. Yeah.
[02:33] Michelle: And I was like, oh, she's a nurse and she has a travel business, and I must know more. And so that's kind of how we connected. And I'm really glad that we did. And of course, we're going to talk about that. But first, I want to just start with what's your backstory. What's your history? How'd you get into nursing?
[02:53] Myra: Well, I joined the Army fresh out of high school, and I was attached to a medical unit. I wasn't a nurse in the Army. I just was a patient administration. And every time we would go overseas or out in the field, I was surrounded by a lot of nurses and doctors. And I was just fascinated by what they were doing. And so I decided, like, okay, this is what I'm going to do. And so that's how I got into nursing. I started going to nursing schools and getting my credentials together and doing my CE'S. And now here we are, twelve years later.
[03:31] Michelle: Wow. Along the way, where did you start in nursing? What type of nursing were you doing?
[03:39] Myra: So I started off at the Cleveland Clinic on a Tele floor in Cleveland, Ohio. I loved it. Then I kind of geared towards hospice. And then I decided to come back to California because at that time when I graduated nursing school, it was really hard for new grads to find a job here in California. So the best thing for me was to go out of state. Plus, I had family in Ohio, so why not? And so now I'm back in California, living it up.
[04:13] Michelle: Well, that's a really cool story. First of all, I love that your first job was clinic. Like, can you get any more world-renowned?
[04:22] Myra: Right, right.
[04:24] Michelle: That's kind of so. Wow. Started off on a telly unit. And how was that? Was there a really hard learning curve for that?
[04:38] Myra: It wasn't really too hard. I think the Cleveland Clinic had set standards, really for you to really learn and really understand that floor. And a lot of the patients that come in with certain diagnoses to really be able to treat them, that's probably why they became number one in the heart. So I had a great preceptor. I had great support during my time there, and I had a lot of great coworkers who just helped me along the way. I had a really great manager by the name of George. That was just awesome and just super. Was just, it was an easy transition because I had a lot of support there and a lot of training and I enjoyed my time there.
[05:22] Michelle: So it was great.
[05:23] Myra: It wasn't hard. I learned a lot. I learned a lot there, especially by talking with the doctors and the NPs who were on the floor. It was just always something new every other week with some kind of training or something new that they were going to try. So I really missed that part of working at that hospital.
[05:47] Michelle: So important, those preceptors and those mentors. Right. Especially as a new nurse.
[05:53] Myra: Yes. And I still keep in touch with that preceptor, too.
[05:56] Michelle: Wow, that's really cool. I wish I could find my ICU preceptor. Right out of school, I did a preceptorship in the ICU and this nurse was so amazing. She kept a little diary for me the whole time that we were there. And it was just these little papers out of a notebook, and she bound them together with some string, and she wrote in them every shift. She wrote the patients that I had, and I still have it to this day. I could go back and it's like Mr. So and So and Mrs. So and So. And this was their diagnosis. And this is what Michelle did, this shift, and she called this doctor. It was the night shift, so we had to call the doctors in the middle of the night. And I had my share of doctors fall asleep on the phone with me. But she was so great. And I have that diary, and I look back on it at times when, I don't know, you're having, like, a self-esteem crisis or, like impostor syndrome, and it just brings me a lot of joy. So, yeah, those preceptors are so great. So from telemetry, you went into hospice. How did that happen?
[07:22] Myra: I went into hospice. It just was closer to my home. I loved it. I actually was doing my BSN program and had to do a community health service for my program. Hospice was one of them that was close to my house and ended up just transitioning, working there. One, because it was more money, and then two, it was just closer to my home, and I actually just enjoyed what I was doing. You really get to connect with the patients and their families at the end of their lives. And just the amount of stories that some of the patients would share with me on their deathbeds was just amazing. And then just participating in their end of life, not only with the patients but with the family as well. So I went to a lot of funerals and stayed in touch with a lot of the family members after the passing because you just build a connection with them. So, absolutely. If I had to pick a specialty to retire, I think I would pick hospice, because, for me, it was rewarding.
[08:33] Michelle: I've talked to a couple of nurses so far who are hospice nurses. One was a pediatric hospice nurse, and the other was an adult hospice nurse. And just hearing their stories and exactly like you said, the connections that they make with the families and that they still have to this day, because I think both of them said the same thing. It's such an honor to be with people at the end of their life, and it's just such a special relationship and man, power to them. I don't know. I think I would be in a constant state of crying. I don't know.
[09:23] Myra: I was crying. I am so sensitive. I was crying. I got a little bit better towards the end of holding it together. And then crying in the car, but I definitely was crying with them.
[09:41] Michelle: It's okay to cry then?
[09:43] Myra: Yes. For me, yes, it was.
[09:45] Michelle: Yeah. I think as nurses, we try to compartmentalize and keep our emotions in check, but it's difficult. We're people and we do get connected. And as a NICU nurse for many years, I got connected to some of the families that were there for a long period of time. And of course, we lost babies and we cried because it was sad and emotional, and we were connected to those parents and those families. So I think that's a good message. Know, it's okay. We're human. These things affect.
[10:24] Myra: Yeah. Yep, definitely.
[10:27] Michelle: So, from hospice, then. Where were you off to after hospice?
[10:32] Myra: I came back. I took a traveling contract and I came back to California, and I worked the jail wards, I worked ER, and then I've worked primary care, home health, then landed in ICU.
[10:50] Michelle: Wow. Okay. That's a lot you got to talk about your work with the jail. What did you do there? Was that like a public health nurse or talk about that.
[11:02] Myra: So, at one of the county hospitals here in Los Angeles has a jail ward, and I absolutely loved it. I was not afraid of the patients because you don't look at them as inmates. You really have to look at them as patients, no matter what the crime that they did. But I had such a great support working there. I think most of my coworkers, were all families, we did a lot of things, so. And my manager, Michelle, at that time was just amazing and super supportive. Working with the deputies on that unit was very supportive and great. You learned a lot, and then you learn a lot about the inmates and their stories. Some of them are not super great, some of them just. But I enjoyed my time there. However, you could get a little jaded sometimes working with them, because once you kind of find out their criminal crime, and that's kind of some of the things I never really asked because then you kind of felt some kind of way towards them. And I eventually started feeling, like, hardened, and I just wasn't at my best and decided, like, okay, it's time for me to walk away from this unit. And then I went over to the ER and had a blast over there.
[12:25] Michelle: For some reason, you strike me as an emergency room nurse.
[12:28] Myra: Yes, I think I work really well under chaotic stress.
[12:35] Michelle: Where do you think that comes from? Do you think your time in the Army influenced how you are as a nurse?
[12:44] Myra: I'm not sure. I think it's just kind of like my personality. For me, I like to keep busy. I love learning, I love seeing new things. So to me that excites me. So the ER was just perfect for me because I just saw so many different things coming in. It was never the same thing. And I liked it because I didn't have to get too close to the family members or the patients. It was just a quick, easy fix. Or it was like, okay, we got to transfer you up to the floor, and let's just keep it going again. I had some great nurses that worked with me, some very old-school nurses, so I learned a lot of old-school tricks.
[13:35] Michelle: Power to the old school nurses.
[13:37] Myra: Yes.
[13:40] Michelle: I love it. I love that you gave a shout-out. Well, listening to you talk about the people that surrounded you at the jail and the people that surrounded you in the emergency room, so what you're describing really is like a tribe, right?
[14:05] Myra: Correct. It is. Everywhere I worked and I've always tell new grads that's coming in. For me personally, it wasn't really about the money or the pay. It was really about the family and the coworkers that I worked with that I can trust them, they can trust me, that they would have my back and vice versa. I would have them, and I would pick that over anything. Because you develop a family, you develop friendships. And I know some people just say, I'm not here to be your friend. I just want to work, to get out. And I don't know. I started nursing almost twelve years ago, and for me, that's just how it was. I always worked a unit where it was a tight-knit family and there was no bullying, and people just, they brought you in and you stayed in and they trained you to be just like them or better, and you just built that trust and I loved it. On every unit. Plus, I think I just have a personality that I can just break up any click. There were no mean girl clicks on every unit I worked on.
[15:16] Michelle: Oh, girl, yay. Can we just get rid of that? Can we get rid of the mean girls? Yes. I love it.
[15:25] Myra: I think I was able to infiltrate every little click and just break it up. And I know people are like, you just come to work and you're so fun. And I said I can't come in here. Whatever happens outside my personal life or whatever I'm going through, there's no room for me to bring it here. I don't have time to focus on that and then take care of my patients and be the social worker, the case manager, and the doctors. There's just no room. And so I learned very early on to learn to separate the two so I can come in and do my best and then go home knowing I did my best.
[16:03] Michelle: Wow, I love that. That's really powerful. And I love that you took your tribal philosophy and you actually put it into the name of your business. Travel with a Tribe. That's really cool.
[16:16] Myra: Yes. You can't do anything without a tribe. At least I don't think I could. I love doing things by myself, but sometimes it's better with more people. And plus, I love collaborating with people. I love talking with people, and I just like learning, and I don't know if it's just being nosy or just curiosity. I just love being around people.
[16:43] Michelle: Were you that way as a kid? Like, were you always asking why?
[16:47] Myra: Oh, yes. I think my teachers used to always kind of separate me and send me in the back. I was talkative, but it didn't work.
[16:59] Michelle: That's great. Okay, so let's talk about your traveling. And you said you did ICU as a travel nurse.
[17:08] Myra: I started an ICU. My preceptor, best preceptor Kyle. I actually call him Dr. Kyle because he's extremely smart. We started off in an ICU in a small community hospital, and then Covid happened, and then that's when the COVID rates and the contracts were coming up and we decided to jump ship and take a Covid contract, ICU contract at harbor, UCLA at LA county, and we have been there ever since. So I started doing that at one of the trauma ICUs, and now I originally came on as staff. I left the traveling and became on staff with them. And so I've been there for almost two and a half years. Almost three years now.
[18:00] Michelle: Wow. So talk about that, like, how is life as a nurse in the ICU?
[18:10] Myra: It can be nerve-wracking. I still come in nervous because I don't know sometimes what I'm going to get. I don't know how the day will be, especially if I've been off for two or three days, what I'm going to get coming in. So I do sometimes when I see new nurses and they're nervous, I tell them, I'm like, hey, I still come in nervous just too. However, I've gotten better at really learning to key in on my assessments. I've gotten better with really just communicating with doctors and getting my charge nurses involved if something isn't right or I feel like I need more assistance or more help with certain patients, it's just what it is. But I've gotten a lot better where I don't have a lot of nervousness coming in. The unit that I work on, again, it's a tight-knit family. We're all on a group text message, so we keep in touch, so it makes it a lot easier. We're a family, too, on this unit, so we're constantly learning and trying to do what's right for our patients. And plus our doctors and the residents and the interns and the attendees are on our floor with us, so that makes it a lot better because you have access to them right then and there when you need them.
[19:29] Michelle: Yes. I absolutely love that. Working the NICU, same like our Neo's were there, our like, we never had to call for anybody, and there's a real comfort in that. Right. It's like, again, the same as your group, and I don't know if that's something that's just particular to the ICU. I would think it is. In those critical care environments, it's like you have to have each other's back, right?
[20:00] Myra: Yes.
[20:00] Michelle: You are a real family. You are a tribe, and there's just a comfort in knowing that I don't know everything. I know there are people here with more experience than me, and I can reach out to them, I can call on them. And just having all the other disciplines there, pharmacy right there, it's just awesome for a code. It's like you don't have to call and you don't have to wait. It's that instant gratification that is really. I don't know. It's rewarding.
[20:39] Myra: Yes, because you just catch everything before it hits the fan, so to speak. So you're constantly with that support. Our pharmacy is on our floor. Our RT's are right there. We have our break nurses. We have our resource nurses who are usually there, and our charge nurses are usually on the floor walking around with us. So that way you can catch everything, and then you have your social workers that are nearby. The case managers are easy to get a hold of, so you can also support the family members. Why their loved ones are in ICU in a critical state?
[21:17] Michelle: I agree. One of the questions that came to me at, like, 02:00 in the morning, because they always do, is, what about follow-up with your ICU patients? Do you get to know what happens to them once they go out to the floor? How does that work?
[21:36] Myra: Lucky for us, when they leave our ICU floor, they go to our step-down, which our step-down unit is right next door. So they're on the same floor. They're just on the other side. So sometimes we can see them. Sometimes we get to kind of talk to that nurse to make sure, like, hey, how they're doing. And we can see some of the family members as we're in the hall. So sometimes we do get to see that, like, hey, they made it. They got discharged or they're in rehab. So a lot of the times the social workers will come back and be like, oh, remember so and so? And we're like, yes, they're like in rehab or they're doing so much better or they're at home. So we do sometimes get to see that follow-up with them.
[22:22] Michelle: I think that's really valuable. It's difficult in that setting because you're just trying to get them through the day a lot of times, right?
[22:35] Myra: Correct.
[22:36] Michelle: Yeah. And then to send them out and never know what happened. Some people like that, like you were saying, like the emergency room, you kind of don't get too connected to them. You see them for maybe a few hours and then they go either up to the floor or they go home or whatever. But I think that follow-up for a lot of nurses is just really important.
[23:04] Myra: Yeah. Especially if I've been with that patient for a long time on the ICU unit because sometimes they're not as easily able to downgrade and transfer them out. So you build this connection with them because sometimes they can be in ICU for months, and then when they finally make it down the step-down and you're just connected with that family, you do want to like, hey, how, what happened? Where are they now? So I'm just blessed to actually have that step-down unit really next door to us to be able to follow up and see how they transition and make it home.
[23:42] Michelle: That's great. Well, you mentioned Covid, so let's talk for just a moment about what it was like working in the ICU.
[23:58] Myra: It was and going back because this was just such a new disease coming out. I think a lot of us on my unit and the nurses that we worked with, we really built a family at that point because we all just didn't know what we were dealing with. We were all exhausted. We were tired at the very beginning. I have to honestly say we didn't have a lot of support from the administration. Sometimes at one of the hospitals that we work at, and I won't mention that name, we had some great doctors who didn't go home and stayed with us on the floors. There were sometimes we were short staff. Some of the nurses would work 16-18 hours shifts because some nurses just didn't want to come in, or some of them were just at that age where they'd just be like, I can't afford to get it. And we completely understand. We weren't really upset about that because everybody has to make a decision. But it was exhausting. It was an emotional roller coaster. There were just times when I was just crying because I didn't understand the disease, I didn't understand what was happening. And there were times when I just came home and I just was like, I don't know if I can get back up and do this anymore. But I had some great nurses that we just stayed in contact and kept texting, and you'd get back up and shower and go do it all over again.
[25:39] Michelle: Well, I have such respect. There have been a lot of stories from nurses, physicians, and other medical professionals. It's just about, I guess, the toll that it took on them psychologically, emotionally, spiritually through that whole ordeal. And you just have to have a really great tribe, a really great team, a really great family to hold each other up, and I love it that you guys weren't judgmental of those. That said, I got to step back. I got to step out of this. I can't do this. I think that says a lot about the kind of people that you are and the team that you had.
[26:36] Myra: Yes, we lost two nurses, and one of our nurses lost her husband. So it was really hard. It was really hard at the very early stages of all of this. So, I mean, just looking back and thinking about it, it just made me really appreciate life. I know sometimes we hear, don't take it for granted, nothing's promised, but you don't really realize that until it happens to you or you're in that situation. And to see family members have to Facetime their loved ones was heartbreaking, too. And then two days later, they're gone, and it's like, what happened? They were up and talking a minute ago, and then they didn't make it. So that was really hard. We had a little break room where we went in and we took a moment. We cried a little bit and then changed our gowns and came back in and kept pushing. We had a great intensivist on our unit, Dr. Taylor, who was just amazing, and she stayed on the floor with us. Sometimes she didn't go home, but it was great to have that support. We had a lot of travelers that came out of state that were just wonderful, had some great experience, and so that really helped us get through a lot of it too, as well, that I still stay in touch with some of the travelers that worked with us. I learned a lot from them too, as well. So we really had a good team. It just was horrible that we had to have that. I met these great people during this time, but I don't regret it and I wouldn't change it.
[28:32] Michelle: Yeah, I think it definitely taught us a lot of lessons about, like you said, not taking things for granted. It's just staring you in the face. One of the things that happened in our unit during that time, of course, we had infants, and so we never had a baby test positive for Covid. We had several moms who delivered prematurely, quite a bit prematurely. Like 25 weeks, 28 weeks. I think we had one 24-weeker or that they were really sick with the disease. And we had three or four moms that ended up going to the ICU and passing away while their babies were still in the NICU. Wow.
[29:14] Myra: Yeah.
[29:14] Michelle: That was just really traumatizing for us. And we had a lot of staff out sick with it. And so it seemed like we were always short-staffed and same kind of administrative problems that I've heard from nurses all over. Lack of support, lack of PPE, lack of staffing on top of all the other challenges that you're going through. They caused a lot of people to burn out and to be traumatized and kind of want to get out of the profession.
[29:56] Myra: Oh, yeah, I thought about it. I definitely thought about it. I had my emotional roller coaster, I needed to leave the bedside. This is too much, this is overwhelming, or I just was emotionally burnt. I just didn't know how to really take care of myself because I had to make sure not only that I was safe, but I had to make sure my household was safe, that I ended up, at one point, getting Covid and had to stay in a hotel for two weeks.
[30:28] Michelle: Wow.
[30:31] Myra: So that was difficult because my family can't see me, but we can talk and chat and make sure I'm getting through the night. And then I had to stay in this hotel, isolate myself for a minute, which really, I had to really sit down and really think about, what am I going to do moving forward? Because I'm going to get past this. We're going to get past this. What's going to be my next move now? Here we are. I'm still at the bedside, but a little bit stronger and a little bit better prepared than when I was when it first came.
[31:14] Michelle: Yeah, I think that's one of the good things that Covid did for us is definitely make us stronger. And I guess I'll say the r-word, more resilient, right?
[31:30] Myra: Yes.
[31:31] Michelle: Yeah. I didn't like that word for a long time, especially in the thick of it when it was being thrown at us from administration. And you guys are resilient, and it's like, yeah, well, eventually that tree that you keep throwing 90 miles an hour winds at, it's bending right now, but it's going to break eventually.
[31:58] Myra: Yeah. I didn't like the word heroes at one point because I'm like, I don't know, I signed up for this. This is my job. This is what I'm supposed to do. So it took a minute for that to really kind of sink in. Like, am I really a hero, or is this just my oath and my job description?
[32:19] Michelle: Yeah, it gave us a lot of things to think about.
[32:22] Myra: Yes, it did. This is where that moment where nurses really took a stand and were like, now you know our worth here.
[32:29] Michelle: That's right. We saw a lot of activism come out of that. And that's a good thing.
[32:36] Myra: Yes. Can't be mad about that.
[32:39] Michelle: So as an ICU nurse, what's the most challenging aspect of the job for you? And on the other side of that, what's the most rewarding?
[32:50] Myra: I think for me, the most challenging is just really trying to get through a day, especially if I have a trauma patient coming in with multiple gunshot wounds or a young patient that's in a horrible car accident, whether it's their fault or not, and then just trying to get them stabilized in a timely manner, and especially sometimes if we don't have the resources to kind of help me stabilize them, can be very challenging because I'm very systematic with what I do and how I take care of my patient. And if something is off, it's kind of like an OCD of mine, and I can't function. So I've really learned how to kind of manage my chaos and my OCD with my ICU critical patients. The most rewarding, too, at the end of the day, when I get them stabilized and all of my lines are labeled and they're looking great is rewarding for me. And when I can have the family come in and say, hey, this is the update. This is where we're at. And then I'm watching their anxiety and their stress kind of come down a little bit, and I let them know it's now the waiting game. You sit at this bedside, you hold their hand, you talk to them, you let them know you're here and we see what happens in the next couple of days. And then when they wake up and get excavated, oh, God. Hugging that family member and being like, we did it, that's what I love the most. And there are. Sometimes they don't get to get excavated or they don't make it, but just being at that bedside with that family member and they're watching every nurse that had their loved ones do 120% and take care of them, and that's rewarding to that family member knowing, like, we did everything possible and then some, like, we didn't give up.
[34:58] Michelle: Yeah. It's so important for the family to be at the bedside and see everything that you do and be involved in the planning and see the assessments taking place and the evaluations and it's so important for them to be there. What kind of ratios do you have in the ICU?
[35:20] Myra: One to two. Unless they are critically ill and on multiple drips, sometimes they'll make them one-to-one, but usually the nurses, one to two. And we very seldom, because it's in California, so we got the laws, so we really very seldom, actually, we really don't go out of ratio here where.
[35:44] Michelle: I'm at now, I think for nurses that live and work in California, we're very lucky. And it should be like that everywhere. And I wish it were, but you spoke a little bit ago about break nurses and resource nurses and how important are those nurses to your workflow and just your day in general.
[36:12] Myra: To me, it's so important because sometimes you can have two patients. They're not very critical, but they're multitasking. You've got so many. You're drawing labs, you're taking to CT, you're doing this, you're hanging an antibiotic, and you can have two patients that just need it. So it's crucial when you have, and it's so helpful when you have that break nurse or your resource nurse that's taking care of one patient while you're doing the other, so you don't feel overwhelmed. So I love it when we have the break nurses and resources on the unit. Sometimes we have overly too many, and that's even great because sometimes you almost feel like you just have one patient, but it's important because it just helps, not overwhelmed.
[37:08] Michelle: I absolutely loved having a break nurse, being a break nurse, having resource nurses. I think when your unit is just fully staffed or maybe even, dare I say, overstaffed, it's like everybody just has this glow from within.
[37:29] Myra: Right, right.
[37:31] Michelle: It's just like I'm going to have time to do everything that I want to do today for this patient, for this family. And I can slow down and I can take a breath, and I just think, gosh, the more days that we have, the more healing is going to take place in all of us.
[37:54] Myra: Yes. And I love it, too, because it gives me time to kind of sit with the doctors that are on the unit and go back and forth with ideas with them and then try to figure out their rationale because then they have the time to sit and explain some things and troubleshoot some things. And then the attending comes by, so it's less stressful. And then now you're more able to participate. You're now in the planning. You're now kind of understanding what's the next step, what's the plan. So it makes it a lot easier for me. When I come into work and I'm doing my job, I feel like, okay, I'm equipped with more knowledge to be able to handle these two patients. And then I have my resource nurse, too. Sometimes we go back and forth bouncing ideas off each other, and so it makes it easier to kind of handle the patient and the day.
[38:52] Michelle: Yeah, it's a different vibe. It's just a different vibe and it's a relaxed vibe. And like you said, so much teaching, so much interaction with the physicians takes place because they feel it, too, and they have more time to teach to discuss cases. And it's just different. And it's wonderful. And it needs to be something that I don't know, honestly, if California is the only one that has implemented ratios as a state, do you have any idea if any other states have done it yet?
[39:35] Myra: I'm not sure. However, I've talked to a few travelers that were out of state but are still here in California on our unit, and they have said there have been some times when their ICUs were one to three, but very seldom. But it's not a law and it's not mandatory. But they've said so far they haven't really been out of ratio. And I've always told them, this is why I'm scared to travel outside of California sometimes.
[40:08] Michelle: Definitely. That would kind of cause you to take pause, right?
[40:13] Myra: Yes, definitely.
[40:15] Michelle: As an ICU nurse, do you float?
[40:18] Myra: We do. We do float to our step-down units to be able to take care of some of the patients that were in ICU. It's very seldom, though, but when we do, we do go to step-down units.
[40:33] Michelle: And how do you like that? Because obviously, you'd have more patients. Is that right?
[40:37] Myra: Yes. It would be one to three at the hospital I'm at now because the step-down units are right next door to our ICU, I don't mind it because sometimes I'm getting the same patients that I had. I'm like, hey, I had you in ICU. So they try to give us those patients back because we already know their history. We've kind of already known what they've gone through and where they're at. So I don't mind it.
[41:03] Michelle: I think it would be cool to take care of somebody that you took care of in ICU that was super sick. And now they're in step down and they're getting better, and just to have that continuity would be very nice.
[41:17] Myra: Yeah. So sometimes when I come over and the family is like, hey. I'm like, hey, we've come a long way. This is awesome. Look at them, they're up and eating now.
[41:26] Michelle: Oh, that's great for them, too.
[41:28] Myra: Yeah.
[41:29] Michelle: I don't know if I read this somewhere, but did you go to a cath lab?
[41:33] Myra: I am. I am also a cath lab nurse.
[41:37] Michelle: Oh, my gosh. So I haven't talked to a cath lab nurse yet. So talk a little bit about what you do in, oh, cath lab.
[41:46] Myra: Well, the cath lab is more of a procedural area. It's more step-by-step. We're not a stemi center, so we don't get the brunt of the heart attacks and the stem that come in. We get a lot of diagnostics and we also do ablations, we do EP studies, we also do IR cases and vascular cases because we're a small community hospital and we have two cap labs and we don't have an IR team. So we are the IR team. But typically a day to day of ICU would be about three to five patients that shift. And it's usually they've had some chest pains, their troponin levels are high, or they've had a history of stent placements. So it's a lot of educating. Most of the patients already, if this is their second or third time, are well aware of the procedures. So sometimes they're not, but it's really about re-educating the patients and the families and then getting them down to the cath lab and starting the procedures. So most of the time, as the Nurse, we are trained to monitor for sedation. At the cath lab I work, we also chart, and sometimes if our techs are busy scrubbed in, we'll pull wires or catheters or we'll help our scrub techs out. So as a nurse, we do quite a lot.
[43:22] Michelle: Yeah, you do. That's really interesting. So what kind of shift do you work as a cath lab nurse?
[43:28] Myra: Cath lab, where I'm at, we do 4-10's.
[43:31] Michelle: Okay.
[43:33] Myra: No weekends and no holidays, and we do two calls a week. So if you're working one of the shifts you can take, call that day. And then we try to do one shift on the weekends where we'll do it. Sometimes we'll do two weekends, but just mandatory, it's just try to do one call during the week and then one call on the weekend once a month.
[44:01] Michelle: Okay. So not horrible.
[44:03] Myra: So not too bad from what most cath lab nurses that I talk to. So we're okay. I've been blessed to work at a great cath lab that's not a stemi center, but I think if it was a stemi center, our on-call would be so different. And then I don't live too far from the hospital, so it's easier for me to take the call and get there quicker.
[44:30] Michelle: Now, do you have to have critical care experience to go into cath lab, or can you go straight there and be trained? How does that work?
[44:39] Myra: So we would prefer you to have some critical care skills. However, in the cath lab where I work, we train you. We will train you. It's a three to six-month training program, depending on where your level is, where your critical thinking is, and how comfortable you feel in the lab. So I would prefer, because I've trained a lot of nurses that come into Cath lab, I would prefer you to have some kind of critical thinking. But if you don't, I'll take you and train you. I'll teach you.
[45:13] Michelle: So one of the nurses that I interviewed, D. D. Finder, I interviewed him as a flight nurse and an author, but he was on another podcast, and he was interviewed because he's an interventional radiology nurse. And that is such a cool specialty, too. And you said that you guys do a little bit of IR procedures and stuff. Very fascinating.
[45:40] Myra: Yes. I know a lot of people like, oh, you do IR, too? And I said, yeah, we don't have an IR team. So the cath lab team becomes the IR team, which is fine. So we very seldom. There's one day where we'll do a bunch of IR cases, and then there's some days where we'll do a bunch of cath lab heart cases, or there may be a day or two where they're both mixed and you just get them done.
[46:09] Michelle: Well, you have done a lot. You have a really wide range of experience, and, gosh, all the way from Tele to Hospice to ICU to Cath Lab, like, you are doing a lot. And then you have this little side thing that you do, except it's not little, it's really cool. And that is your travel business. So I would love for you to talk about that. How'd you get started in that, and what do you do?
[46:48] Myra: Well, I think once Covid kind of stopped and we were allowed to travel, there was a moment where I realized like, hey, I just want to see the world. I want to do something different. And I had a coworker of mine who was just traveling and just constantly going somewhere. And I remember him telling me, Nurse Gamble, you're young, your kids old. Go do something different. Go see the world. And I was a little nervous, and I was like, no, I don't want to go. And I don't know if the Internet just hears me talking. And then an opportunity popped up for a group trip to go to Turkey. I had followed the group for a while and I was like, you know what? Okay, I'm going to go. I didn't know anything about Turkey at the time. It wasn't even on my bucket list to even go. It was just, okay, I'm just going to go. And I took the leap a year and a half ago, met some amazing friends on this group trip. And then I decided, like, I just love traveling. I had an amazing time there, a different culture, and different experiences, and I never stopped. I just kept going. I keep going on trips now. Then I realized that there were people like me that just worked and we never took vacation. And so I decided to create a travel business for working professionals or people who just work and don't have time to plan or organize trips. And they just like the convenience of somebody else organizing it, and all they have to do is get a plane ticket and meet me in that country and I will take care of the rest.
[48:46] Michelle: I think that's so seductive for so many people who maybe like you said, they haven't traveled a lot and they're kind of like, I don't want all the headaches. And to have somebody handling all of these details for you is just so much relief. And then it kind of brings the joy back.
[49:09] Myra: It does. Every time I'm in a new country or I'm taking a tour and I'm learning about the history, I come back with so much knowledge, and then I keep reading, I keep kind of keep getting more information about that country. And I'm like, oh, I didn't know that. Now I'm telling people, like, did you know this? Did you know that? And I feel like now I'm a walking encyclopedia.
[49:35] Michelle: That's so cool. And I love that you went to Turkey. I feel like I have a very strange relationship with Turkey. And this might sound really weird. I've never been there, but I feel this pull like I've been there before, especially to Istanbul. I feel like I maybe was there in another life if you believe in those kinds of things. It's really weird, but I feel like I'm going to have to go there.
[50:07] Myra: Oh, you do! You have to have to go. I loved it there. I actually would love to host a group trip back to Turkey. I'm just not sure when. Maybe in 2025. But I absolutely loved it there. I loved it at Cappadocia. That was fun. Just the people there were just really nice. In fact, most of the places that I've gone, I haven't run into anybody rude or unpleasant. I've had some really good experiences in most of the countries that I've been to.
[50:44] Michelle: Are most of your clients, are they nurses or medical professionals?
[50:50] Myra: Some of them are. Some of them aren't. Some of them are just people who have run across my page on Instagram or Facebook and have reached out and we've had conversations and have just joined my group and are traveling with me. I have my first girls' trip to Egypt coming up in April. These girls that are coming with me are people that I've worked with in the past or met on a different group trip and have just decided, like, I just absolutely love hanging out with you, Myra.
[51:26] Michelle: And you have a trip coming up to Greece, is that correct?
[51:30] Myra: Yes. I'm currently doing a coed trip to Greece, June 30 through July 8th of 2024. And I'm excited about that because I went to Greece last year and I absolutely loved Greece. If I could pick a place to live, I would pick Greece. I just loved the idea of the ocean and then jumping on ferries to go to different islands. And the food, to me, was amazing.
[51:59] Michelle: Yes.
[52:00] Myra: I have another group trip to Greece.
[52:02] Michelle: Coming up that would definitely be a pull for me. The food. Greek food. Oh, my gosh, yes.
[52:09] Myra: Because I love to eat.
[52:13] Michelle: Well. That's one of the great things about traveling. Right. And in different cultures you get to experience all that different food.
[52:20] Myra: Yes. And their spices and just how they're cooking things. And I love going into the town and trying to eat what some of the locals experience and what they eat. Some of it I like, some of them, I don't. But hey, I like to say, hey, I tried it.
[52:39] Michelle: Exactly. It's like we're doing what our parents always told us to do when we were little, right? When we say, I don't like that, and they're like, you haven't even tried, like, try one bite and see, you might, like, know. And sometimes we, and that's the great thing about experiencing all those different cultures. And I love your Instagram, Traveling with Myra. So @traveling_with_Myra and your website, that's Traveljoy, right?
[53:10] Myra: Yes, that's what I'm currently using right now for my advertisement.
[53:14] Michelle: That's great. Let's say I'm someone who feels very out of place while traveling, and I'm asking for a friend. I actually do feel out of place, and that's kind of the point, right? You're not in your regular place, you're somewhere else. But if someone feels uncomfortable traveling, how can I become more comfortable with that? Do you have any suggestions?
[53:47] Myra: Well, first, too, if anybody comes on my trip, I'd always make sure I get on a Zoom call with them. And then we have a conversation, and so I could see what are your barriers. What's your anxiety? And then I try to help paint that picture, like, okay, this is what's going to happen. This is what we're going to do. And then when we first get to our country, where we're going, it's always a welcome dinner so we can all sit down and we can meet. And then I try to do a group chat once everybody is locked in and is going on this trip, so we can all have a familiar face and we do Zoom calls throughout the experience. So prior to when we get there, we already feel like we know each other. And so I always try to make sure I have a one-on-one with that person to say, hey, you're in the best hands. I got you. We're going to get through this. However, here are some other people that are now in this group, and you can build this friendship with them first before we arrive, and then once we arrive, once we have that welcome dinner, I make sure you're comfortable. I make sure I'm there with you, guiding you and helping you through this. And sometimes I may push you to experience something different to get outside of that box because my ultimate goal is whether you're traveling with me or in a group, I just want you to be able to leave this trip and feel comfortable to be able to go on another trip, whether it's by yourself or with another group, just go out and see the world.
[55:21] Michelle: Those things are all great. I definitely would welcome any of those. The Zoom call, the welcome dinner, the group chat. I don't know if I'm different than a lot of other nurses, but I think the way nurses work is we're kind of very methodical and organized, and we kind of like to know what's coming. In a way. I think most of us don't love being surprised. And so those kinds of things would definitely lower the anxiety level about going to a new country and just all the little details that go into organizing a trip. So it's great that you do those things.
[56:07] Myra: And I also try to pick some trips that I've already gone to that country, so I kind of already know what to expect. And if I don't know what to expect and I haven't been there, I will definitely let them know. But for the most part, I'm trying to pick and host trips that I've already been to that country. So now I have a little upper hand. And I said, hey, I've been here. This is what to expect. And so that kind of help brings the anxiety down a little bit. So we're just not walking into something that I don't know.
[56:42] Michelle: Yeah, I love that. That's great to have kind of like a personalized tour guide with you, somebody that's already been there, somebody that's already experienced it, somebody that knows kind of the ins and like, that would definitely decrease my anxiety level as well. What have some of your clients said that have gone on trips so, so far?
[57:09] Myra: My first one will be Egypt.
[57:11] Michelle: Okay.
[57:12] Myra: So that's going to be my first one in April. So I don't know just yet, but I'm hoping that they will absolutely enjoy it and have a good time. And most of them, like I said, are some of them that I've worked with and they've already liked me and working with me on the floor. So they're definitely going to love me in Egypt.
[57:32] Michelle: I love that. Now, are people still able to register for the Egypt trip?
[57:38] Myra: They still are. We still have till February 3. Absolutely. To still join in on this girl's trip to Egypt. That's my cut-off. I actually have one that I have a Zoom call with later this afternoon who's interested at the last minute and I'm so excited and welcoming her.
[57:58] Michelle: Okay. And the Greece trip, when is the cut-off for that registration?
[58:03] Myra: Registration for Greece will be on May 4.
[58:06] Michelle: Okay. I'm going to put all those links in there to your website, to your Instagram. I don't know if we're going to meet the February 3 by the time this airs. Yeah, that's definitely the May 4 for Greece.
[58:21] Myra: Yes. Thank you.
[58:23] Michelle: Yes. Very cool. Well, I mean, other than Instagram and your website, where else can we find you?
[58:29] Myra: On Facebook, under Myra Gamble.
[58:33] Michelle: And do you have an email that you want to share?
[58:37] Myra: My email is travelwithatribela@gmail.com.
[58:45] Michelle: Awesome. Well, thank you, Myra, for being my guest today. And I'm in awe of nurses like you who just have so much experience. And I love your voice. Like, you sound so relaxed and just so chill. Like, I would love to work with you.
[59:05] Myra: Most of my coworkers do. And they always make fun of me because they're like, you do everything. When do you not work? Because I'm constantly, always working. If I'm not on the floor working, I'm doing something for my business.
[59:19] Michelle: Yeah, I love that. I love that you have the business and that you're encouraging others to, like you say on Instagram, take your PTO, don't just bank, like, use it. That's what it's there for. And you need that, especially if you're a medical professional. You need to get out. You need to get time. Absolutely.
[59:48] Myra: Absolutely. I always come back refreshed. I just got back from Panama and Colombia and I had an amazing time and I loved it and I didn't want to come back, but I'm back.
[01:00:02] Michelle: Reality sets in. I've loved living vicariously through you on your Instagram and seeing all the places you're going. That's really cool. And you've really inspired me to travel. I said this a couple of episodes ago when I was talking about retirement. But one of my goals this year, since I'm having a milestone birthday, is I have wanted to see the Milky Way galaxy. And so I asked my listeners to let me know, where can I see it unencumbered. And I've looked at some places in the US, but, yeah, you've just inspired me. Like you said, get out. Step out of your box and see the world. Right? There's a lot out there.
[01:00:54] Myra: Yes. Go do it, Michelle. Don't wait. Go and do it. Just do it. I met a lot of people, especially when I went to Egypt last year and I climbed up the pyramid. And I remember meeting a couple that looked like they were in their late 60s, or early 70s. And I remember them telling me I wish we had done this ten years ago when I was able to climb these stairs.
[01:01:23] Michelle: Yeah.
[01:01:24] Myra: And so I took his camera and I said, well, I'll take the pictures and video it for you. And I did. I took his camera, I took his phone, and I took some pictures and I climbed up there and videotaped it as much as I could for him. And he was like, thank. Really? That was that pivoted moment where I'm just like, no, I got to start this business because people need to get out. Just go, Michelle.
[01:01:51] Michelle: Yeah, I know. I have that analysis paralysis, and it's like, no. Do you just need to do it? Just pull the trigger and jump on it and do get a.
[01:02:03] Myra: Just book it and then you'll figure it out later.
[01:02:06] Michelle: That's right. Everything is figureoutable, right?
[01:02:09] Myra: Yes.
[01:02:11] Michelle: I've loved talking to you, Myra. Thank you so much for being my guest.
[01:02:15] Myra: Oh, thank you for having me. I appreciate this so much.
[01:02:20] Michelle: Well, you know, at the end, we do the five-minute snippet.
[01:02:23] Myra: Yes.
[01:02:24] Michelle: So it's just five minutes of fun. And I have my timer. And so you're ready to play?
[01:02:30] Myra: Yes.
[01:02:32] Michelle: Sweet. Okay. And when I picked this question, I had no idea of your history. So this is kind of funny. This is a this or that question.
[01:02:47] Myra: Okay.
[01:02:47] Michelle: Army or Navy?
[01:02:49] Myra: Army.
[01:02:51] Michelle: I was like, that's going to be an easy one for her, right?
[01:02:54] Myra: Yes.
[01:02:55] Michelle: Okay. And would you rather be a court jester during the Middle Ages or the king's food taster?
[01:03:04] Myra: Well, I was voted class clown in high school. I think I'm going to do the king's food taster because I love food.
[01:03:12] Michelle: Okay. Is there a magazine that you would like to be on the cover of?
[01:03:17] Myra: Maybe Vogue? Because I'm not good with style at all. Somebody can style me.
[01:03:24] Michelle: Have a restyle. That'd be fun.
[01:03:27] Myra: Yes.
[01:03:28] Michelle: Okay. Football, baseball, or basketball?
[01:03:33] Myra: I'm going to go with basketball. Since I played that in high school, I'm going to play basketball.
[01:03:38] Michelle: How cool. Do you have, like, a pro team that you follow?
[01:03:42] Myra: No, everybody's a winner to me.
[01:03:45] Michelle: That's cool. Okay. Would you rather be a cowgirl during the Wild West or a jazz musician during the Roaring 20s?
[01:03:56] Myra: I'm going to go with jazz musician since I played the clarinet and the saxophone before.
[01:04:02] Michelle: Whoa. There you go. I love saxophone.
[01:04:05] Myra: Yes.
[01:04:06] Michelle: Okay. First class or coach?
[01:04:09] Myra: First class.
[01:04:11] Michelle: Oh, my gosh, I love it. So I flew first class for the first time this summer when my daughter and I went to Seattle, and it was a total mistake. I thought I was upgrading to business class. And as the flight attendant told me, no, those are those unfortunate people behind you. When I asked her, are we in first class? As she's, like, bringing us drinks and food and everything. So. That was so fun. I'm with you. Yeah. First class. Have you ever been kicked out of anything? And if so, why?
[01:04:48] Myra: No. So far, no.
[01:04:51] Michelle: You're going to have to put that on your bucket list. Get kicked out of something.
[01:04:56] Myra: Yes.
[01:04:58] Michelle: Would you rather be an extra on a movie set or a stunt double?
[01:05:04] Myra: I probably would like to be an extra on a movie. I'm not too good at doing any stunts.
[01:05:11] Michelle: That'd be fun to be an. Huh?
[01:05:13] Myra: Yeah.
[01:05:15] Michelle: Okay. Taylor Swift or Beyonce?
[01:05:19] Myra: This is tough. I like both. I probably say Beyonce, yeah.
[01:05:27] Michelle: They're just both divas, right?
[01:05:30] Myra: Yes. They're amazing. Yeah.
[01:05:32] Michelle: I'm really into Taylor Swift right now because of Travis Kelcie and the Chiefs.
[01:05:36] Myra: Yes. Congratulations to them.
[01:05:38] Michelle: Thank you. Yes. Okay. Would you rather get paid to play video games or review books?
[01:05:47] Myra: Review books.
[01:05:49] Michelle: Yeah, I'm with you.
[01:05:51] Myra: You have no pay.
[01:05:54] Michelle: And if I got paid on top of it, it's like, okay.
[01:05:58] Myra: Yeah. Do you know how many books I would read?
[01:06:00] Michelle: Exactly. Right. Okay. Ice cream or gelato?
[01:06:06] Myra: Ice cream. Ice cream.
[01:06:09] Michelle: Okay. I can't wait till you plan your trip to Italy, and then we can have Italian gelato.
[01:06:18] Myra: Right?
[01:06:19] Michelle: Okay, last question. What's your typical Friday night look like?
[01:06:26] Myra: If I'm not working, I usually, with coworkers, will usually just grab a bite of dinner and then just kind of chitchat and hang out. We like to dine at one of the sushi restaurants that's close to our jobs or one of the local bars that's near our homes as well. And it's just a way for us to kind of just debrief.
[01:06:53] Michelle: Debriefing is so important.
[01:06:56] Myra: Friday night is usually dinner with coworkers or if I'm not working, it's usually with my son. It's one time, if I'm not working, that we have our moments where we can hang out and cook dinner, or we'll usually go get a bite to eat.
[01:07:12] Michelle: I love it. Family and friends, right?
[01:07:15] Myra: Yes. And maybe my dog.
[01:07:21] Michelle: This has been a lot of fun. Myra, you're amazing.
[01:07:25] Myra: Thank you. Thank you. Yeah.
[01:07:27] Michelle: Love talking to you. I'll put all those links in the show notes, and I just appreciate you being here today.
[01:07:35] Myra: Well, thank you for this opportunity and your podcast. I'm still nervous about it, but it's already done and over with now.
[01:07:47] Michelle: Girl, you are so good. You're going to love it. Thank you. I know my listeners are going to love you, too. Have a great rest of your day, whatever that entails.
[01:07:59] Myra: My business. I got some things to settle into, but that's all I got to do today.
[01:08:04] Michelle: Well, there you go. All right. You take care.
[01:08:08] Myra: Thank you. Bye.