Love of Doing Nothing.

Six glorious weeks off. It's 11:20am and I have done nothing today so far, except heat up some soup my mom made me. My boyfriend and I are heading to the Hangar One tasting room in Alameda with a few other MEPNs today, just for fun.

Realizing that there's nothing due, that I can read for fun, and that I don't have to get up at 5:00am for any purpose is a fabulous thing.

Done with Med-surge quarter. Now: enjoyment. The big questions: To work or not to work, to ski, to travel, to sleep.

Ahhh, vacation.

For a Patient.

Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
And Immortality.

We slowly drove, he knew no haste,
And I had put away
My labor, and my leisure too,
For his civility.

We passed the school, where children strove
At recess, in the ring;
We passed the fields of gazing grain,
We passed the setting sun.

Or rather, he passed us;
The dews grew quivering and chill,
For only gossamer my gown,
My tippet only tulle.

We paused before a house that seemed
A swelling of the ground;
The roof was scarcely visible,
The cornice but a mound.

Since then 'tis centuries, and yet each
Feels shorter than the day
I first surmised the horses' heads
Were toward eternity.

-Emily Dickinson


Morpheus

Oh, Morpheus, give me joy till morning
For my forever painful love:
Just blow out candles' burning
And let my dreams in blessing move.
Let from my soul disappear
The separation's sharp rebuke!
And let me see that dear look,
And let me hear voice that dear.
And when will vanish dark of night
And you will free my eyes at leaving,
Oh, if my heart would have a right
To lose its love till dark of evening!

Alexander Sergeyevich Pushkin


"There's no place like home."
-Dorothy Gale, from Kansas.

Honoring one of my favorite patients, who will probably not make it 48 hours.
I think she recognized me for a second today. She smiled, for just a moment in her confusion and pain.
And then she simply said, "I want to go home."

Maybe I'll see her tomorrow. Maybe not.

Whatever happens, I am grateful to her and her family for allowing me to help them. I am grateful for their love, which teaches me to love in kind.
And I hope that when she does go home, she finds peace.
Sometimes, holding someone's hand is all you can do.

Namaste.

Feeling Alive and Radiant.

The above photo is of Upper Cherry Creek, of Cherry Bomb Falls, a Class VI section of whitewater that Will has rafted. I was part of his backpack support, which was incredible- It was a magical hike, although I was jealous that I didn't get to be in the raft (it was just him and another burly guy), but then it started snowing and I watched them run this rapid at 5pm in June in the Sierras at 6000 feet. In the snow. Yeah. I slid down the granite into camp on my ass, because wet granite is like ice.
It was one of the most difficult and beautiful backpacking trips of my life.

The past two weeks have been tiring - no, exhausting - but something has happened that awoke my spirit. I can't pinpoint it. Well, I can, but I can't publicly describe it. It's like being hit viscerally with this sense of knowing that's beyond a doubt, like walking into a room, seeing something or someone and feeling your stomach fall through your feet. I've felt like something has been coming for a while from the universe/energy/out of the blue/god/whatever, and every day just seems to get better and better, and yes, something has happened. I'm meeting more people who have my same values and interests, always exciting, but it's not *they* who are the cause of this vibrancy; I think it's the fact that my fire is lit up that's bringing them into my life. Know what I mean?
Like sometimes you meet someone and they're a mirror, and you know you have a lot to learn with that person, and that means you're on the right path.

And it's not just the people, - I mean, people definitely excite me, and I'm dorky that way- I'm always wanting to know what makes someone tick, and I'm always curious.

It's kind of the brat in me. I. Want. To. Know. Now. NOW.
Hee hee.

There are opportunities and places to explore and stuff to get involved in that had been tough to find- from medicine to community to job leads. Until the past oh, month or so. Like things are coming together.
I feel like an excited kid when it comes to everything, except a little bit smarter.
And a little shy. But that's another story.

I feel in love with life again.

Will and I are doing well. He came back, and we have deepened our love to a place I didn't think it could go. Honesty. I likes it. I told him some difficult things this week, and we've talked through them. I've never been able to be so raw with someone, and it's been amazing. I feel incredibly lucky to be with him.

Everything I'm doing feels like it has a purpose. This week, someone asked me to describe myself, and one of my words was, "Intense." He nodded and gave me some of his own stories, which I was surprised by. He's not the only person that I've had this same conversation with this week (although with him it was the most intentional and clearest). It's like similar people keep finding each other, over and over.

Intensity. I can't do anything that's not wholehearted. Even writing a paper has me mildly stoked (well, okay, pushing it- but the topic is good).

I keep looking back at what's made me feel the molecules of my soul in the past, and I want to share some of those things with you:


There is nothing like rowing the 226 miles of this river. I miss every day I got to be out here. I faced a change in confidence by rowing rapids that were, for lack of better words, huge, and by having to trust myself to take care of the people around me. I grew so much in the Big Ditch.
And at night, all you get is a strip of stars above you- the walls of the Canyon are so dark that they suck in light. You haven't known dark until you're camped here, and the stars tease you, winking, and if you're lucky, you might get to see a sliver of moon.


More Tenaya Creek at low water- same place my header photo was taken (actually this is looking up the creek instead of where our feet are, which is looking down), but in October. My best friend and I went hiking a few weekends ago, and I didn't realize how much I missed granite.


Rivers up in the Trinity Alps. Don't get me wrong, I love the Sierras. The Trinities have other beauty to them. This was the South Fork Salmon, and wow was it cold. I'm guiding here, on a little 8' drop that was super fun.


Oh yeah, and corsets. If you haven't figured *that* out.

And emergency medicine. And not writing papers. And procrastinating by blogging. And being bratty. And reading anything that's not studying material.

And opening to life.
Opening.

Strangely, for the amount of intensity that has been coursing through me over the past 3 weeks, I feel extremely grounded.
Just really, really...
Happy.

Letting the light shine on!

High in the Sky Apple Pie Hopes

Today is election day. I'm heading for an observation again in the hospital, in my ABSOLUTE favorite spot, the ICC-
and then I'm voting.

Yep. I'm voting.

Because an ANT can move a rubber tree plants. And people can change things if they work together.

Turning Seasons.

When you are in clinicals, or are working in an acute care setting, you will understand why I love that LOL cat.

Fall is here. It's getting colder, we're getting a little bit busier, although there are only four weeks left of this quarter.
Papers are due soon. The last time I wrote a paper? About 9 years ago, so the foray back into APA format has been somewhat like a jog down memory lane after gaining about 85 lbs. I feel out of brain breath. Make sense?

Someone said that MEPN is like running a marathon. Nah, running marathons involves sleep. A lot of people take "mental health days" here and there, and I have to say I wholeheartedly agree.
This last weekend I went over to the eastern Sierras with my best friend, and we camped out in Jeffery pines and Aspen trees that were golden with the sunset. We hiked around at 7000 feet at the same place my headlining photo is from, and there was no water in the creek. It was awesome, to say the least. I was reminded why I chose nursing as a career path- it fulfills my love for patient care and (hopefully) allows for having a life. I have to live outside. Have to. Non-negotiable. My boyfriend and I are already planning some backpacking trips once I'm out of school.

Wow, four weeks left in this quarter.
Four.
Then we're halfway done.

Today I looked around at everyone and just had this moment where I realized how much everyone has learned- people were so nervous, so unsure of themselves when it came to talking about patient care, not to mention actually doing it - and now everyone trades information and speaks to each other like, well, like nurses.
It's really really cool.

Since my last time in, I spent some time in the ED (emergency department to those of you who don't speak medicine), which completely re-lit a fire under my ass. I loved it. Working in emergency always ignites me, and I even got to do some charting under the auspices of my nurse preceptor. She challenged me to do an assessment on an ortho patient (yes!- easy, what I *always* used to do while patrolling), who had a bad bicycle accident. I did a full assessment, checking my patient's neuro function, asking if she could remember what happened, did she lose consciousness, etc. I assessed her breathing/ribs and cardiac function. I checked all peripheral pulses and cap refills, paying special attention to the one distal to her injured forearm. Very carefully, I wrote down my findings, scared shitless - I mean, it was on real ED charting paper from a major hospital, and my words become legal. After sweating for a few minutes, I figured, well, hell, if the RN I'm working with doesn't like what I'm charting, she can shred this and start over.
I got praise. I was stoked.
I also got to hold traction later, working with a doctor who had a gentleman with an obvious shoulder dislocation. We didn't get it back in. I've reduced a few of those in the field, and when I saw this one, I thought to myself, "Ooo. That's bad..." so when it didn't go I wasn't surprised.
We had such an amazing variety of patients: people with liver dysfunction, people in withdrawal, abdominal pain, an Acute MI (heart attack), that I saw only briefly on my way out when my shift was over- there were so many people in the room that I wasn't able to be a part of anything anyway.
I also inserted a Foley on a guy who was having a rough night. I'm sure that didn't help. The night was busy.
I'm not a night person, but I was completely awake. Our observations are only 3pm-11pm, but I stayed until midnight, ecstatic to be back "at home."

Other than that, I think the program has been relatively manageable this quarter. The final papers are kind of a pain, but they're almost done.
Back to back 12 hour clinical shifts are tough, and for each student they're tough for a different reason.

I'm thinking about doing a quick advice column for things I've learned with the MEPN year so far.

Sorry this posting is so disjointed but one reason I haven't written in a while is lack of sleep and personal time. I got personal time this weekend, but sleep is yet to come...
Oh yes, and Halloween is coming. No we don't get out early from clinicals.

Love, Bluegrass, and Tears.

Ah yes, 5th week of "schedule A's" quarter, and I'm deep in Med-Surg nursing. Still on the transplant floor. Still doin' my thing.

Last weekend I rode on a float in the LOVEfest parade down Market St in SF. If I could find a photo of me on the Spundae/Skills float, I would, but alas, I was in my EMT pants and a T-shirt, although I had my hidden orange fur and sparkley pants in my bag. I was supposed to volunteer from 11am until 4:30, and ended up staying until 6pm. We had so many calls- lots of overly intoxicated people on various substances, and I was running around with oxygen on my back trying to help them. Doing the quick assessments was actually kind of fun, because it brought back my EMT skills and I was surprised at how comfortable I felt in that environment. A lot of people thanked us. Afterwards, I found some friends and danced until about 7, went home, and drank a margarita. Sweet.
Sunday I went to Hardly Strictly Bluegrass since it was only a mile or so from the house, and had a fantastic time just chillin' with close friends. Listening to Iron and Wine play was magical, as was dancing with the girls to Greg Brown. Awesome day.

Today was a tough one at the hospital. Last week, I took care of a patient who was hoping for a good diagnosis. He didn't get one. He has an inoperable state, and at this point, he has been referred to Hospice care. He'll be here for a few more days, and I'm going to try to be with him tomorrow. His wife is phenomenal, and I cried with her for about 20 minutes this afternoon. There's not much time to give, but what I have, I will.
I can't go more in depth, but that still makes me tear up. Knowing that your parter is going to pass, knowing that you are going to pass- given "time" to do what you need to do... Is it a blessing? He has the opportunity to say what he needs/wants to the people he loves, yet it's limited.
His wife looked at me and asked, "Why is it that we only find out who truly loves us when we're sick or dying? Life is so short- time goes by so fast and we keep promising each other that we'll get together, and it takes something like *this* to make it happen. Why?" She paused, looked at me, and said, "Enjoy every moment you can. If you learn nothing else as a student, enjoy every moment you can."
That's when I started crying.
I hugged her.
In the middle of the hug, my stupid cell phone started vibrating, and we both laughed and laughed. Perfectly ludicrous.
They've been married for 40 years. I've been with my boyfriend for 2.
My heart aches for them.

And then there is that question: how *do* you go back into the hall and help your patients after that? How? My heart was heavy, but I got elbow-deep into poop (literally- and discovered a pressure ulcer and worked to prevent skin breakdown) and tended to the needs of someone else who is, very literally, dying.

Inoperable.
Bad word on our floor, but seemed to be the word of the day.
Sigh.

All we can do is love openly, celebrate the time we have, and be here for each other.
Those words from my NP friend echo through my head: "There's not a day that goes by where I don't hug a patient or am there for a patient. I give good news and bad news. When I've lost my ability to emote, then it's time to move on from this."

I'm just getting into it, and it's heartbreaking and beautiful all at the same time.

This weekend I'm at a wedding. A beginning. I think I need it.

Firsts, Escapes, and Anniversaries.

First of all, if any of you readers are applying to MEPN right now, congratulations on finishing. Tonight at midnight is the deadline, and I remember all to well scrambling to get it all in.
In fact, the GRE made sure that I was late by a week, but somehow it all worked out. Have faith that yes, indeed, it will work out for you.

Non-MEPN stuff: I went to my first same-sex wedding in the beautiful Genessee Valley area of California. My friends Julie and Abigail tied the knot in the best ceremony I've ever been to, out in the middle of nowhere on their property past the North Fork Feather river.

Almost all of my river friends were attending, and I had a weekend of margaritas, sleeping bags and dust boogers that made my fall happy. This weekend, I'm volunteering in the med tent at the LOVEfest, hosting a few women at my house who are going to Hardly Strictly Bluegrass, and just unwinding. The Gourds are playing, and they play the best version of Gin and Juice (which, incidentally, Will plays on his banjo). So will Emmylou, Iron and Wine, and Poor Man's Whiskey. Sweet.

I miss Will. He's in Houston, doing hurricane relief, still. Probably there until December.

MEPN stuff:
Last week we had rapid response on our floor 4 times, once for someone with 10/10 chest pain and shortness of breath with a low O2 sat- ended up that patient didn't have an MI (heart attack- or "myocardial infarction," an "infarct" being an area of dead tissue due to lack of oxygen). And then another patient had Atrial Fibrulation alternating with Sinus Tachycardia. It was a chance for me to be the EMT on the floor; when the docs said, "get oxygen tubing" I already had it and the christmas tree (the attachment that allows us to connect tubing to oxygen). I also ended up printing out the ECGs for them. Yay! That was exciting.

Also firsts, some not so good: first long-term patient death. Sigh. Remember, yes, my info is changed due to HIPAA, so I don't always get to tell you everything that's happened. I will say this, the patient's room always smelled wonderful, due to aromatherapy, and I loved being in that room, regardless of how good or bad the day was for him. I took care of this patient about 3 days. He was waiting for a miracle, was young, needed more than one organ. He died waiting in the ICU from a massive internal bleed. His platelets were always low, and the clotting factors were always at critical values. And there were reasons for that, but it doesn't make it any less sad.
I haven't cried yet. I need to share this info with another MEPN who cared for him even more intensively than I did. The info I'm giving you, public, is different than what really happened, but it affects me nonetheless. I spent last Friday thinking about this person and remembering interacting with his family.
My heart felt heavy.
It's different, you know, when it's someone you've met briefly, than when it's someone you've helped out with on a day-to-day basis. Someone you've advocated for, watched the doctors go in and talk to, watched the discussion by the teams as to whether they're going to get what they need or not.

I started my first IV, a 20G on someone who's a "hard stick" and I nailed it. Proud? No: Glowing. I hate needles, and I faint when people come near me with them, so I'm uber aware of how I treat people with them, and I'm all about being a phlebotomy pro. I always used to get the hard sticks at Planned Parenthood, and now I feel like I did well with someone in the acute care setting, and I'm willing to go further.

A MEPN saved someone's life last week. She noticed a fever, and essentially caught early sepsis on someone. It wasn't someone who had had a ton of patient care experience; she was just very observant and very dedicated. And she's smart.
One small light, a small flickering flame that glows just enough for one person to see can change the world.
I hope that if I ever get sick I'm lucky enough to have this person as my nurse. She's awesome.

It's that time of year when we're getting sick, sore throats, tired - even though our schedule has eased up. Our first test is tomorrow.
MEPN is tough. Many of us have gained weight, lost partners, lost sleep.
There's a lot I'm editing, but more will come to light later, when I'm done with this program.

For now, it's all about the basics, the day to day stuff, the hopeful living and breathing and learning that we all do together.

For you applicants, think about nursing, and imagine yourself with someone at they're most vulnerable moments. Yeah, you'll hear a lot of jokes about "wiping ass," - which incidentally I do a lot- but think about being with someone when they're vulnerable and need that help. What an honor it is.
If you can't see it as an honor to be with someone when they're so sick they can barely take care of themselves, then this pathway is not for you.
If you feel that you have enough love for the entire world, with a little left over for yourself at the end of the day, then by all means, walk through the fire and do it, because it's worth it.
What a fucking honor. Every day.
The light in me honors the light in you. Namaste.
Whatever your reason is, let is shine forth in your essay, and best of luck.

Holding Each Other Up.

What a beautiful day.
The sun was out, it wasn't too hot, and we got into some people.
What a beautiful day.

The above image is a painting by Susan Seddon Boulet, and I believe it's entitled "Isis and Osiris," a myth I've loved since I was a child.
It ties into healing; how Isis loves her brother so much that she hunts down his body parts and puts him back together. The image of her cradling him in her wings is a very powerful one- he seems to float in this peaceful space even though he was just recently utterly destroyed. It's what love can do: make us whole.

Today was amazing: we had good news; we had bad news. One woman in our clinical group described the honor she had in spending what she knew (and her patient knew) were the last moments/hours in his life together. She was there with the patient and the chaplain, and was able to be a part of an in-depth conversation about death/dying and fear, and ways to live even in death. She teared up as she described this experience, and wondered how the hell one walks out of the room, into the beeping, the lights, the rush of the rest of the floor- so *alive* and bustling- while still keeping it together.
I don't have an answer for her, except that I don't keep it together all the time.
Her story made my heart ache, and even now, even when I should be going to bed, my thoughts are with my classmate, because I have no idea how the hell I'd deal with that situation either. How beautiful to be a part of someone's death, to be wanted in one of the most intimate lonely times in our lives, yet to feel so helpless-
As our new clinical instructor said, "You can't just say 'I know how you feel,' because, well, you haven't died."
Good point.
Speaking of, someone who I thought *was* going to die is alive and well and back on my floor. A patient I had 4 weeks in a row, I was ecstatic to see her doing so incredibly well, better than I've ever seen. She received a new organ, and it shows. We were able to talk today about her favorite pesto recipe- I swear that sometimes, patients just need to be reminded about life outside the hospital, and they often instantly perk up or become a bit "better" just by thinking about not being sick.
I had an ecstatic day. I learned a lot, worked with one of my favorite nurses (a guy who totally rocks), really helped out the patient that I had- I actually *felt* like a patient advocate, AND I got to see a rockstar ICU nurse/CCRN whom I adore in the ICU. Which I buzzed through for a moment to see if she was there.
Stellar. Day.

I also got to hang out in radiology/ultrasound for a bit, and saw a kidney, about 6 hours post-transplant, that was functional. It made me overjoyed for my patient, and it was an excellent learning experience as I asked the resident to teach me how to read what was on the screen. Awesome.

Okay, not much, and everything, and I'm exhausted. 12 hours tomorrow too.
This quarter is a bit easier, but I can't tell if it's a time thing or just the fact that we're used to school.

Today. In pictures.

How I felt by 10am today, even though I learned a lot, dealt with the ENTIRE rainbow of human fluids (except a male specific one, thank goodness), and tried to get a patient ready for transport:


What my 5pm-6pm hour was like:

Except it really looked more like this:


How I felt after a 12 hour shift:


How everyone else felt all day:



What is fixing my sanity now:

And:



What I'm about to watch:


And how I feel altogether at this moment:



Except I've got a glass of wine in my hand, thankfully.
It really was the craziest, most stressful, ridiculous day I've had on my floor. I have a glass of wine and Licorice scotty dogs from Trader Joe's to make me warm and fuzzy. Oh yeah, and that thing I call my bed... yes!

Ch-ch-ch-changes.

Getting up at 7am again is tough. Getting up at 5am tomorrow is the most daunting activity I can think of. If I didn't have an automatic coffee maker, I don't think I'd make it through this first half-week.
So, the class is now divided into two: Schedule A and B. The A team has advanced med-surg nursing this quarter with a communication class. The B team has Community Health and Labor & Delivery with a class on Socio-Cultural issues. We're bummed as a class to be split up, but it's also really nice to have such small classes.

I'm following the A schedule. We're back on the same floors, and now there's only two MEPNs in our transplant world - not counting the nurses from previous MEPN years. Some guy passed two of us dressed in our conspicuous green tops/khaki bottoms in the hospital hallway, smirked and whispered, "MEPNs..." which made us giggle- he waived and wished us luck. I wondered when he had graduated, or what portion of the master's he's in.

My boyfriend took off to do hurricane relief in New Orleans for FEMA. Actually, we both work for a subcontractor to FEMA, and we are well paid for our work. Helping people get the aid they need is a difficult job sometimes- getting the proportions right when reconstructing property can be tricky. I couldn't go: they require a two week commitment. Will is there, doing housing inspections, and we're all holding our breath to see what happens with Hurricane Ike. They're still doing some cleanup from Gustav, and Ike is forecasted to be even worse than Katrina. I'm hoping everyone evacuates and stays safe. The Texas coast is supposed to be walloped.

Back to school:
I'm excited for this quarter, more excited than I thought I'd be. For one, we have a super stellar professor from last quarter. My advisor was co-teaching with her, and left (and I totally support her- she's a phenomenal clinician from whom I'd love to learn, but she has stuff going on that's important We get to hang out in the ICU, the ED(Emergency Department) and the OR to observe.

We start 12 hour clinical days as well. Tomorrow is the first one of the quarter. We'll see how it goes...

Sorry this entry is so short, but it'll be an early day mañana.
And I'm totally absorbed in House. Heh.

Good things today: met my super-awesome MEPN buddy, hung out with friends, had a great conversation with a nurse/professor I admire, re-connected with some of my favorite nurses on the floor, had a short clinical day, almost got to paddle outrigger canoe.

I had some real connections with people today. Whenever that happens, it qualifies as a great day.

***********************************
Today is September 11.
Take a moment to remember.
Take a moment to look forward.

That's all.

Ahh, sleep and relaxation.

Okay, so, a few things I got/get to do during my all-too-short week off from school:
1) Went to Burning Man. I usually go for 10 days, and this time I went for 3. I have photos of the COOLEST art car I've ever seen- a giant duck with flame torches on its head (which is a golden disco ball), a body that changes color- fading from yellow to green to purple, eyes that beamed halogen lights into outer space, a great sound system, and a tail that functions as a dance cage. It blew everyone away. To quote a Burner friend of mine, "that duck was the belle of the ball!" Apparently it cost over $300,000 to build, and the people in the front/back had $5000 headsets to operate it properly. Yes, I kid you not. This thing was spectacular.

Pics of the Duck in day and night:




Sorry the first night shot wasn't so good, but I was tired and it was about 3 in the morning after the Burn. The art cars made a huge wind break out in the middle of the Playa between the Man and the Temple (which was also beautiful) and created a wind-free dance space that was *the best* I've been to yet. It was REALLY fun, but tough to rally to sunrise. The heart car was pretty rad too, and the DJ was incredible. There was also a giant Tetris game, which shot of fireworks every time you leveled up.

1a) Met some awesome folks at Burning Man, including members of Comfort and Joy camp, Black Mamba camp, saw some of my best friends, survived a lot of dust, sat under the Willow tree art installation, and nearly had a hand fasting ceremony that was cut short by a night-time white-out (a night-out?) after the Temple Burn. Spent a lot of time under the Willow tree, met the artist, and when I can find a pic of it, I'll post it because it was insanely beautiful. Okay, here's one, but I need a night shot:



2) Hung out in Truckee, my old stomping ground. Took a final there, online. Met up with some good friends, got drunk on mimosas with those folks and did absolutely nothing, unapologetically. Did laundry, cleaned Playa dust off of myself and my clothes. Woke up in my old house next to the river. Felt peaceful and happy. Sipped coffee. Had bloody marys with breakfast. Felt lazy. It was perfect.

3) Slept. Still sleeping. Lost 5 pounds, sleeping. Okay, well I did dance a ton at the Burn. But sleeping is good.

4) Heading to the American River Festival. Might be paddling with my old race team, sans one member. In fact, there's a distinct possibility that I'll race with them in Argentina in November, but that remains to be seen.

5) Declined being deployed by FEMA to do hurricane relief, which would make me between $450-$1000/day. I have to have 2 weeks availability, and that's not gonna happen. Sigh. Oh well. I'd rather sleep anyway.

6) Probably going to volunteer at SFGeneral ED to try to wrangle a job there eventually.

7) Ate sushi. Still eating sushi. That and sleeping are top priorities. As well as being lazy.

8) NOT thinking about school. Enjoying good weather and the ability to bike ride.

9) Lost my advisor- she quit. Wondering what that will mean, but see number 8, and you'll understand where I am right now. I'll send her an email in a while.

10) Going shopping with girlfriends and drinking foo-foo drinks midday. I'm on vacation. :)

Sunny Days

So, it's the last week of school. We've already finished our clinical finals, although we have clinical days on Thursday and Friday- which are simultaneously torturous and wonderful: torturous because, well, it's Labor Day weekend and we all want to leave early... and wonderful because it's always cool to spend time with patients and be there for them.

This quarter has been a whirlwind. I feel like I've been in school for a year, not just 10 weeks. Our class is constantly being told how "collegial" we are, which I would certainly agree with- people are so *nice* and it really makes a difference.
Pathophysiology is over for those of us who are satisfied with our grades. Pharmacology final is today, only 50 drugs, our teacher ROCKS, and then we're done with lecture. Our Fundamentals of Nursing final is next Tuesday, but can be accessed online anywhere, so that gives us a lot of freedom.

It's almost over. I can smell a break coming... and I need it, desperately.
Quick synopsis of what's going on right now: the gym is closed, which is driving most of us insane since we have a workout group, and during our "finals" week, we'd love to be exercising consistently.
I'm looking forward to the next quarter. There's a possibility that my clinical instructor will change, which would be fine- either way I'm happy.
I had the opportunity to shadow in the ICU yesterday afternoon, which blew my mind- when they say "intensive," they're not kidding. The woman I was shadowing won the CCRN award of the year, is a very experienced nurse, and had the most complex patient on the floor. I didn't even know such a thing as an EVD existed. Needless to say, it was an afternoon of learning. I ended up meeting someone who was quadriplegic, helping a doctor translate for a Spanish-speaking patient, and just bumbled around in awe of the care provided in the ICU. I saw a few doctors from the transplant floor I'm on, and remembered that the liver/kidney transplant patients usually spend some time in the ICU immediately post-op.
It was wild.
It was the extreme of nursing- if nursing were an extreme sport, then ICU care/Critical Care is akin to dropping waterfalls in a kayak. You have to know exactly what you're doing, and even then, things can still go wrong.
Awesome.

I also got a call from SFGH for volunteering in the ED. I figured it would be an excellent way to figure out if being in the emergency department is what I really want to do. It's only 5 hours/week, although I say that now and I know how precious five hours to myself are. I need to call them back and schedule an interview at some point this week.

That's the news at this point. There's a very mild possibility that I'll be paddling in Argentina on November 25th this year with my old rafting team. I had a healing discussion with one of my friends on the team, and felt like I was listening to myself a year ago. We'll see what happens, but the opportunity to compete internationally really calls me. This next quarter is a bit less strenuous time-wise, so I'm thinking I'll have some time to paddle outrigger canoe. It's all up in the air.
More later this week! Week 10! Yay!

Blogging, Exhaustion, Anonymity, and the Four Agreements.

Today after clinical skills lab, I felt deflated, defeated and just drained.

Part of it is due to last week's drama, and drama is something I've been cutting out of my life, but part of it is just sheer exhaustion.

One of the MEPNs, on our way out, took me aside and thanked me for my post on week 8.
"I felt so exhausted and strained, and I was wondering if it was just me, but when I read what you wrote I felt like, ok, I'm still here. I can keep going."

Awesome. I nearly cried, except I've cried so much since Thursday last that I couldn't muster the tears. I should have hugged her but all I could think about was getting home to sleep.

In any case, you know who you are, and thank you so much for making me feel like I have a purpose, because if I help one MEPN, I've done my job in blogging. Otherwise I feel that "big brother" is reading this stuff and judging/grading me on whatever I write, and I tend to stifle myself. You, MEPNs, who are reading this make me brave. Thank you.

That's the problem we who blog face: simultaneous "fame" without anonymity. NurseSF was smart in keeping herself hidden for a while; there are days I wish I had that freedom. I wonder if it would be smarter to have kept myself quiet. I'm not so good at that, but hey, I deal with whatever comes. It's the river guide in me.

Sleep well - I will be. And remember, no matter what, revert to the four agreements, which I will review:

1) Be IMPECCABLE with your word.

Let that sink in. Words have power. Language structures consciousness. No matter what you say, it has the ability to echo in someone's head for years.
And that means being careful about what I say. And that means not modeling the language that was thrown at me, recently. Ever.

"Words are like arrows, once you let them go, you can't get them back."

2) Don't take anything personally.

Often, when we are attacked on a personal level, it's not who we are or what we have done, it's the perception, it's *that* person's interpretation of what we've done. Obviously if we've truly done something wrong, we need to be accountable first and apologetic second. A good apology does not start "I'm sorry, but...", a good apology is simply a heartfelt, "I'm very sorry" (not a stoic one). So, my point is when people speak harsh words at you, listen to what's being said and glean from it what may help you in the future; however, don't take it personally. Let it be the energy that it is. We have the choice to take on negative energy or to emulate positive.
I choose the latter. I choose the positive. I personally detest drama, I avoid negativity, I avoid deception and lying, and I choose not to take anything personally, even if someone else does. Although I'm having a somatic, viscerally negative reaction to the world over the past week- I am consciously and constantly redirecting to the positive, because that is my choice. It is better for me.
We are capable of our own consciousness. Remember this.

3) Don't make assumptions.

People will generally tell you what they need from you. I wish that in the heat of the moment that people would take this agreement more to heart, but I am not everyone else, and I can only speak for me. The world runs on assumptions, yet I still feel that I could make an "ass" out of "you" and "me". Heh.

I realize how many people have read/do read this blog, and I am very conscious about keeping things harmonious. I like harmony. I like being friendly and happy with people.
MEPN wasn't gonna be all sunshine, rainbows and lollipops, I knew that. Thank goodness for the ruby slippers, the professors we have. And thank goodness for my classmates.

4) Always do your best.

This agreement is one I truly practice, and I can say that with complete integrity. Last week a nurse on our floor who I wasn't working with/hadn't worked with directly asked if I was going to apply for a job next year because I had been so incredibly helpful (made sure someone who fell multiple times in a night had emotional support and physical support the next day- got her laughing and up out of bed safely, made sure she didn't fall). I felt so honored by that question, and at the same time, totally humble, because I didn't do anything different from what my clinical expectations were. That question was a bright light in my day. I didn't even get to share that with anyone else because other stuff was happening that wasn't so bright. In any case, it was a reminder that my best is sometimes seen and heard, and for that I am humbly thankful.

I gave everything that day.
I give everything every day.
I am always giving and doing my best.

I like adding a "fifth agreement": Laugh at yourself.
When we stop being able to laugh at ourselves, we stop growing.

In any case, life goes on, and it's week 9. The faculty in this program continue to be awesome- our actual professors are incredible on so many levels, and they have been sources of sanity for me and many other students. Encouraging, responsive, and warm are characteristics I would pick to attribute to them.
My fellow MEPNs are amazing. This class is very unified, and we've been helping each other out tremendously - someone posted notes for Pharmacology that were great, some of us have been outlining chapters of reading - we were told yesterday by one of my favorite professors that this class is "very collegial." Hell yeah.

I leave you with the four agreements. I'm mulling them over, and have been, which transitioned nicely into the lectures on spiritual care and end-of-life care we just had.

Be impeccable with your word.
Don't take anything personally.
Don't make assumptions.
Always do your best.

Interlude... Burning Man.

After reading a fellow classmate's blog, and realizing how much this blog needs a little extra touch on life outside nursing school, I decided to focus on what's keeping me sane:
Knowing that no matter what, I'm heading to the Playa.

Unfortunately, the weekend-warrior thing absolutely sucks to do out there, but on the up side, I get to go (once school is over). I didn't think that was the case when I started, and I've been looking at my costumes hanging in the closet rather sadly, dreaming of "out there."

When you hear people say "Burning Man," and you're not a "Burner" (ie one who attends Burning Man, one who likes to light random things on fire in a desert environment), do you think, "Oh right, that drug festival in the desert?" or do you feel a visceral "hipper than thou" reaction? I hope not.
Burning Man is based on the idea of forming a community, well, okay, let me backtrack- I should say the building of Black Rock City:
The temporary city of up to 40,000 people that forms every year out in the Black Rock desert is an experiment in the best of human giving and living.
It's all based on self-reliance, a non-currency economy (although you can bring money to buy ice and coffee), and amazing art pieces.
It's unlike anything you've imagined.

First of all, it's hot, at 4000 feet elevation, and dry. That combined with usually a bunch of cityfolk who aren't used to what my river peeps call "hydration, hydration, hydration" can make for a quick visit to the med tent for an IV. Add alcohol, any other substance on top of that, and you can see how taking care of yourself becomes very important.
But the fun to be had if you can take care of yourself is awesome. Imagine a life-sized Operation game. Yep, exists. Yes, you get shocked for real if you mess up and touch the side of the bread basket. Heh.
Imagine the "Billion Bunny March" where bunnies march for bunny rights. How the hell did that start? I don't know, but there's a Carrot Liberation Federation that marches against their Bunny oppressors and they generally have a peace summit every year that involves drinking. There's the largest light saber fight ever that takes place yearly at Center Camp at sunset on Thursday, where 10,000 people battle it out. There's Cube, a 3-D LED sculpture that is solar-powered and AWESOME, programmed to make various "moving" pieces in its spot, so it looks like it's raining or has a rainbow or all sorts of stuff.
And the costumes. The costumes range from Renaissance style to Mad Max. Incidentally, the Thunderdome is there, and it opens every night with opera. I kid you not. It's huge:

And you thought Dance, Dance Revolution was awesome? Try "Dance Dance Immolation" where you wear a fireproof suit and try to follow the steps. If you mess up, you get blasted. Yes, with flamethrowers. It's RAD. Safety third...

And every morning, bacon wafts around the Playa. People greet each other with Hugs, not handshakes. Artcars take you on adventures. YOU take yourself on adventures, and mostly by bicycle. It's the most amazing place I've ever been to, and I've been to a lot of really cool backwoods spots.

That's my rant. I can't wait to get out there.
My point is, if you like Costumes, freedom, artwork and the unexpected...
and bacon (bacon is a known trade item at the Burn- many friends are made via Pork - and why not? Salt, electrolyte replacement and protein after dancing all night? Yum!), then the Burn might be for you.

It's a place of absolute fun, amazing invention, and human connection. And although I'm not going for the entire time, it's really home for me, so I'll be there for a few days this year. I never thought I knew where I belonged until I went to Black Rock City.
We also had a really interesting talk this week on end-of-life care, and on how we let go of things. If you're familiar with the Temple at Burning man, then you know that it's a non-denominational sculpture, meant to be burned, where people can go and write all week long, bring pieces/mementos from their loved ones or their lives or ANYTHING you want to let go of, and on Sunday night, after the Man burns, the Temple goes- and everyone is silent.
It's beautiful.
It's an amazing ritual, and one I do not plan on missing.
In any case, there's some insight to my world other than nursing.

Ruby Slippers

It's been a while, mostly because I've been trying to figure out how to put the experiences of the past few weeks into words, and also because 8th week is hellishly exhausting.
There's a light at the end of the tunnel.

In essence, the best way to describe my emotion right now is humbled, a little confused, tired, and very very determined.

8th week is when you're most tired, but you can also see the light at the end of the tunnel. It's when everyone starts to break, when tempers go, when people get sick of dealing with each other, and when we all start to snap. But, remember, from those breakdowns come rebirth, rebuilding, re-shaping, and a stronger, clearer consciousness.

I will also say that I had no idea regarding the depth of my classmates' compassion, empathy and support until this week. I knew they were good, but they warmly surprised me, and I am very grateful.

In any case,
Thank goodness for two things this week: Bikram Yoga and Ruby Slippers.

Bikram yoga has been a source of sanity for me for a while in my life. Aside from being hot yoga and a great workout, it's really about controlling your breath, and about being grounded and situated in the moment. It's main message is to be mindful.
Lord knows I need that.

Ruby Slippers have supplied my sanity in the form of a 4'11" Italian-from-Boston smart-as-a-whip nurse(CNS)/professor who could arguably be dubbed an unofficial hero(ine) as far as our class goes. If you end up in the MEPN program, are in it now, or have done it in the past two years, you (will) know who I'm talking about.
I had a tough situation this week, created a bunch of crap for myself- totally my own fault- and just when I thought I couldn't take it anymore, right when I was about to crumble, she walked onto my floor, put her arm around me, and whisked me away.

Until she walked around the corner, I was a complete wreck.
Her energy is so incredibly positive, so clear, so *real* that you can't help but drop any defenses, because you don't need them.
We took a break in her office, to chat and let me get myself together.

Hell, I would have gone to Kansas when she came and got me if it meant just taking a break from where I was, but I ended up in a place with a friendly vibe, the radio playing one of my favorite songs, and I immediately relaxed. Anyone who has Wizard of Oz commemorative items on their walls is okay by me.
There were more Ruby slippers in this room than you could ever imagine.

Something about sparkly red shoes just makes everything alright.
In fact, when I asked her about them, she said, "Hey, sometimes I just need to click my heels too."
Rock on.
We had a really direct, poignant conversation that was incredibly helpful. I felt like I had the ability to keep going, which was not the case 15 minutes prior.
Perception and reality; these topics I was left to ponder, and you know what? I got it. I understood what was up, and knew exactly what I needed to do to make the bumpy road smooth again. Instead of feeling defeated, I felt inspired.
She encouraged me to get back on the horse, make the day a new one, and go forward.

When we left, I felt like I was wearing a little of that sparkle. I had to check my shoes a couple of times that day.

So, a reminder to myself and to others, slow down. Slow down in our processes, slow down in the intensity of this program, slow down and take a breath and think, slow down and just take a breath.

And if you need to, click your heels three times and take those 5 minutes to yourself. When you don't know what to do, just breathe, and let the answer come to you. It's not about fast, it's about learning, about doing things right.

And ultimately, it's still about your patients. If you can't be there for yourself, how can you be there for them?

Magnesium and Bananas, Oh My.

It's the little victories that rock my world.

Today was awesome. NB, readers, I'm going to be writing more and more about my clinical experiences, and be assured that they all comply with HIPAA. Identifiers have been changed to protect patient privacy.

Okay, now to the good stuff:

Today I felt like a nurse. We (my nurse and I) had 4 patients, 3 of them a bit more intense than others, and the other one was being discharged (of course, we got one to replace her, a pre-operative transplant patient).

Our patient being discharged was a cancer survivor. I say survivor because that woman has moxie, and said to me, "Failure isn't an option. I've got way too much to do in my life." Rock on. When she refused a cocktail of electrolytes before she left the hospital because it would have kept her there another 2 hours (after she had been there almost a month), I saluted her. Her NP said, "Just make sure she knows to eat some bananas and chocolate."
No problem.
Her energy and enthusiasm made my morning. She'll be back for more treatment, but not for very much. Sweet. I'd go home asap too. Hospital food sucks, and having home around is sometimes the most healing thing to have.

Those little victories keep me going.

The short version of today: assessed a distended abdomen, caught diminished lung sounds, discovered people had been taking blood pressure on someone with a fistula on the lower arm, in a place where the cuff was too small... remedied that by taking it on a lower extremity, changed a central line dressing using sterile technique, rinsed a lot of commodes, talked with the rounding team of docs about getting better/different antidepressants for a pt who really needed them (and when I came back from lunch, psych was there! They rock!), took out a Foley, did a bladder scan, researched a 5 page MAR for another HIV+ transplant recipient, got a pt to laugh who hadn't laughed in 3 weeks. Oh yeah, and changed a colloidal dressing. Took a few blood glucose levels. Saw a patient with a pancreas transplant. How cool!

I took a very short lunch.

The long version of today? I gained people's trust, identified a female patient's discomfort with having male nurses deal with her perineal area and alerted the nursing staff to that - which they were happy to accommodate (which made me happy), hunted down the all-important lip balm, charted correctly (huge accomplishment), followed C. diff precautions (had an ET moment... Eliott), and got a very distant patient who has huge failure-to-thrive potential to be more engaged, aware, and tried to give her a goal.
She's the one I made laugh. I hope it works.
Sigh.
That's all you can do, you know?

It's interesting. I wrote about what an *honor* it is to participate in patient care. I mean, truly- think about it- you're helpless, you can't pee, you can't get to the bathroom in time, you're puking, you feel like crap... and you're vulnerable.
And there's this person there to help you out.
I'm that person.
I feel honored to be trusted with those: the most vulnerable moments. It's not about "cleaning poop" (although I certainly went through waterfalls of it today- not kidding), it's about knowing that the patient trusts me to be there in a pretty dark hour. And not judge.

If you've ever sat up with a friend who is 1) way too drunk or 2) way too high on whatever or 3) in the middle of a high-drama breakup, you can get some understanding.
It's sorta like all of that at once, and then add fear to it.

I feel so grateful to be able to sit here, sipping on a cocktail, writing my blog. I come away from my day with appreciation for the little things. No matter how tired I might be after a shift, I could still go back. We're only at 8 hours on the floor right now, but that's going to change in September.

For future MEPNs, and to myself 2 years from now: what I do daily is awesome. I like raw humanity. If you shy away from that, you run the risk of having a difficult time, no matter what nursing program you go into. Remember that honor. Always remember that honor. You have the opportunity to help someone in a way that nobody else can. As a MEPN, you might feel helpless, but you know what? Nobody else has spoken to that patient you just spent a half hour with, because nobody has time. Nobody else took the time to listen to fear, anxiety, to let that patient tell you about her dogs, his trip to a foreign country.
Or maybe you speak a language that the nurses don't speak, and because you speak Mandarin/Spanish/Russian/Thai/Swahili you can connect with that patient in a way that nobody else has time to, and you give them a glimmer of understanding of what the hell is happening.
I am taking full advantage of my student status. Look stuff up. Educate yourself. Ask questions.
Okay, that's my rant/rave.
I worked with an awesome nurse today, and I hope I get to work with him again. By far, a naturally easygoing person with infinite compassion and highly intelligent. Great combo.

Oh yeah, and learn to let go at the end of the day, if you can. And good luck with that.

Lessons Learned: Week 5

Not a lot of time right now, but I was reflecting on last week's dichotomy of humor and despair. That's kind of what it's always like: an emotional roller coaster, and you've just got to stay stable.

We're learning what honor it is to be a nurse. I mean, really. That's part of week 6's lessons, but it seriously hit home for me in week five.

The most difficult thing, I learned, is not to watch someone die or even lay there and suffer.
The most difficult thing for me, I've discovered, is to watch the eyes of someone who loves that patient, and who has loved that patient for decades, as that patient is treated, tested, writhing in pain, out of it.
When you see the partner of a patient- and that partner is so alive, so intelligent, and so present, and then you look over at the patient helpless in bed, struggling to remember his name...
And then you see the way that partner looks at your patient, as the doctors and nurses place the ECG electrodes on that patient's body - you see that partner's eyes, and you look at their wedding rings, and you realize that the sweating, hyperventilating *person* in the hospital bed who can't even tell you his/her name at that moment because they're so out of it is *everything* to this person in the room, who stands in the corner, out of the way, strong, keeping it together, letting us do our work, stabilize, extend life another minute, hour, day.

I lost it for both of us. I had to leave the room and duck into the closet. Trauma has never bothered me, but that look in her eyes cut me right to the soul.
I fought tears, and lost.

A fellow MEPN (and good friend) asked me, "Did you see her eyes?"
"Yes. That's why I had to leave."
He nods. "I had to leave, too."

We just stood there, hugged each other for a bit, sighed, and went back to taking vitals.

Later that day, I found out that another patient had received a final cancer diagnosis, and that it was not only extremely early, the prognosis was very good, AND it was treatable. She hugged me and we jumped for joy together.

A nurse practitioner friend of mine told me that not a day goes by that she doesn't give bad news, good news, cries, laughs or hugs a patient. And she says if you can't feel, it's time to leave the profession.
I think I understand why.

Remember: there's a life in front of you. There's a person in that bed. We are so much more than the sum of our diagnoses.

Humor in the Process

Some topics make people really uncomfortable.
The very first clinical day, I mean the FIRST Tuesday of skills practice, one of our instructors did a mock interview and included these words: "Fist Fucking. Depending on where you work, you're going to have to ask questions about things like this, things that make you uncomfortable. Don't shy away. Is that clear?"
The class, half in shock and half in awe, nodded quietly.
Oh yeah. Crystal.

This week's topic wasn't about fisting, but it was about "nutrition and elimination."
I think people forget just how much they lose control of their body when they're really sick, or maybe they just ignore their daily functions, especially those that are a little more private.
But nurses? Nurses cut right to the chase. "Did you have a bowel movement today? If so, how big? What was the consistency? Color?"
A lot of people would run screaming from the very thought of having this conversation.
Nurses have to dive right in, and there's no pussyfooting around it.
We measure pee. We look at poop. We clean up poop.
And we insert catheters. Oooof.
If you've ever had a catheter, you know that you want someone who has some idea of what he or she is doing. It's not pleasant. But guess what? We are about to practice on our unassuming patients (under supervision, of course).
We are also now able to, ahem, administer enemas and do digital extraction.
If you don't know what that is, use your imagination.

There are some things that river guiding actually DID prep me for- there's a saying among guides, "All we ever talk about is boating, sex, and poop."
Oh yeah, and alcohol.
But seriously, having to discuss the groover, asking people on LONG multiday trips if they've used it (a HUGE issue, I assure you), has allowed me to be a little less afraid of this, um, new frontier.

The practice catheterization was hilarious. Imagine walking into a room with a bunch of fake "show-ers-not-growers" mounted on white plastic boards with fake bladders, all set out on a table, next to about 10 other vulva models mounted similarly... and that was Tuesday morning.
I've posted some photos just to let you all know that you, YES you, can be doing the same thing.
Nobody kept a straight face, but it was seriously rewarding when your Foley actually made it into the model bladder. Hope you can see what's up.

We also did NG/FT insertions (naso-gastric and feeding tube), which weren't too troublesome, although on a live person who might puke on you, I'd imagine it's a bit tougher.

This week, we're responsible for total patient care for three patients, including monitoring InO (Ins and Outs - anything that goes in, and anything that comes out).
Soon we'll focus to one, total care, including meds, IV, etc except for narcotics.

And it's only Week 5. Oh yeah, we're about halfway...

Ambling along.

An early Sunday morning. You know you're in school when 8:00am feels like sleeping in.
The infamous parrots woke me up this morning. Yes, parrots. In San Francisco. Apparently they like to summer in the Parnassus/Cole Valley area, and this morning I discovered that they love apple trees.
That was actually a novel alarm clock.

In any case, we're done with our 4th week, and into the 5th. By the end of this week, we're halfway through the first quarter. It's pretty amazing to see how much we are learning. Tomorrow we have another pathophysiology test (yay) and we have some relatively difficult homework in Pharmacology where we have to investigate a toxicology report for Ms. Vickie Lynn Marshall.
Then there's the usual reading, heaps of it.

The patient care is awesome - Friday was by far the most interesting day I've had as far as variety of problems, and alertness/communicativeness of patients. I saw my first pressure ulcers, which the wound nurse confirmed as stage I and stage II. The nurse I was shadowing is AWESOME, lots of experience, moves fast, and is by far one of my favorites to learn from. We got that patient taken care of, dressed the wound properly, and started ambulating the patient. I can see why it's such a problem though- when you have thin skin, a recent MAJOR surgery, and someone in pain, it's hard to turn the patient every 2 hours. Somehow, though, we did get the patient moving, which also got the lungs to clear.
Sigh.

Someone called a code that I got to cancel. Incidentally, someone decided that the code team members should wear all black. Not kidding. How morbid is that? Hmm, the "death angels" or the "pirate-ninjas"? I guess the person in arrest isn't gonna know one way or another, but I thought the decision was pretty morbid.

Friday was also a day of A-Fib (wild to listen to), learning more meds, checking vitals, learning about HIV, catching an infiltrated IV - Me: "I think it looks swollen, and the patient says it stings." Nurse: "Well, Medicine can sting sometimes." Nurse looks at the arm, and says, "It looks okay."
5 minutes later, Nurse: "You were right, good eye, it was infiltrated. Here's how we deal with it."
I thought that was really cool of her- for one, any praise we get we thrive on- and of course I'm going to defer to the judgment of a 20+ year nurse. What really got me was that even though she's been a nurse for two decades, she listened to my observations and took the time to double-check things- she didn't have to, but she values anyone's observation, including a brand-new student. I really respect that, and I told her so, "thanks for listening to me." Her reply, "when you stop listening, you stop growing and learning. Everyone's input is valuable, and when it comes to patients, it's better to double check then to let it be. Remember that."
I nodded.

That's probably the best advice I've had so far.

I also shook a patient's hand good-bye - she thanked me for helping her out, which made me want to help her more. When I left, she was just about to undergo a very very painful procedure, and I wanted to be there to hold her hand for it, but time didn't allow.
The conversations I had with that patient were some of the most intriguing I've had, but I have to save that story for another time.

MEPN is a constant balance of emotion, work, schoolwork, and time for self. The latter gets lost, so I'm determined to do a bit of that today.

A Vignette.

I think today my emotions are catching up with me. I was completely devoid of any feeling until I decided to go work out, and while on the elliptical, after being up since 5am, a Genesis song came on- "Follow You, Follow Me."
The tears started coming. Just waves of tears, which kept coming until the woman on the machine next to me startled me by asking if my workout always counted backwards from 60 minutes. Startled, I choked out an answer, "Um, I don't know- I was off in la-la land. Sorry."

Thankfully the workout was almost done.
And when I got home, the tears started running down my face again.

Today was relatively easy, as far as patient care goes, at least I thought.

This vignette has been haunting me (stuff is changed so that I don't violate HIPAA):

The nurse I'm shadowing and I are in a patient's room. Yesterday we've determined that although he understands some English, when it comes to medical procedures and medicine in general, Spanish is the best language to communicate in. He's lived in the US quite some time, very kind, mild mannered, and he is very sick with an organ failure and transplant rejection. He's having problems- including a very high fever, and they don't know why, although it might be due to a bacterial colonization of his rejected organ.

A team of docs is rounding. One doctor approaches him, the others stand back, watching him like he's in a Holiday window scene. Nobody touches him, yet everyone's eyes are focused through an invisible divider. He sits at the edge of his hospital bed, mellow, calm, quiet - either too sick to care, or simply peaceful. I am curious about the physician's process, and I immediately realize how intimidating and how isolating this approach must make him feel. One doctor begins to give a history on him, the basics that healthcare providers are taught to do. Someone in the back pipes up, "Um, he speaks Spanish" (the day before a physician had just spoken English to him very slowly and loudly, as though he would instantly learn a new language if she could just increase the volume- if that we're true, I'd have Cantonese down pat by now). The doc starts over, begins to speak decent Spanish, interjecting English here and there when she doesn't know a word. I softly ask, "Entiende?" (Do you understand, sir?), to which he replies, "no," and I explain what they're saying, quietly. My heart aches.

All the while, the other doctors scribble busily. Their heads are close together, and they're bent over their charts in Gumby-like positions, looking up at each other. One of them is flipping through the chart madly, searching for test results. I'm reminded of the scene in "Alice In Wonderland" when the scribes in the Queen's court keep repeating "That's very important..."
".....`What do you know about this business?' the King said to
Alice.

`Nothing,' said Alice.

`Nothing WHATEVER?' persisted the King.

`Nothing whatever,' said Alice.

`That's very important,' the King said, turning to the jury.
They were just beginning to write this down on their slates, when
the White Rabbit interrupted: `UNimportant, your Majesty means,
of course,' he said in a very respectful tone, but frowning and
making faces at him as he spoke.

`UNimportant, of course, I meant,' the King hastily said, and
went on to himself in an undertone, `important--unimportant--
unimportant--important--' as if he were trying which word
sounded best.

Some of the jury wrote it down `important,' and some
`unimportant.' Alice could see this, as she was near enough to
look over their slates; `but it doesn't matter a bit,' she
thought to herself....."

Has he had this test? Why not? Who missed that? Why has he had this problem for this long? What's going on? Why are the results not faxed? We need to order this test!
I ask him about the particular test. He states it's been done. More than once. He'll do it again he says, shrugging his shoulders. It's not a test I'd do again. Even the physician says, "Once is enough for anyone. And you've done it more than once." A glimmer of humanity and humor shows through, eases the tension.

More fervent scribbling, heads down, focused on the papers, no touching, no smiles, just serious business.
It's comical. It's tragic. I stifle a laugh, because I honestly cannot believe how dehumanizing this process is at this point. Deep breath.

Outcome: An antibiotic changes. The group leaves. A passing good-bye from one physician to the patient. They bustle out the door to review the next person's medical history, which I know will teach the new residents a lot, and make them very good at what they do.
My focus now is to get good at what I'll be doing.

His nurse and I exchange glances. We leave the room and don't even have to say what's on our minds. As we're walking down the hall, she breathes, "Sometimes, it's kind of a circus." My chest feels heavy suddenly, and I don't know why.

Don't get me wrong- the physicians are AWESOME. They are highly intelligent, respected, and amazing at what they do. They work extremely hard, and provide excellent care. But sometimes, it seems like the teaching process can be incredibly dehumanizing. I know that bedside manner is being taught more in medical school, but if nothing else, that experience today was a stark reminder of how distant medicine and science can be.
And how frightening- Imagine being so sick in a country where you spoke most of the language, but when it comes to medical procedures, things get difficult to understand. Part of me wonders how often we think of this fact. His nurse and I discuss this point of view extensively, and check on him more often. He's not feeling very good today, and we both know that.

Two hours later, this man has a fever of 103F, and his respirations are alarmingly high. Is it the fever? If so, what's causing the fever? Is he septic?

One of the doctors, a newer MD, very friendly, told me yesterday that many of the patients die of DIC. When I ask what that is, she explains, "Disseminated intravascular Coagulation. It's horrible. Basically, they go septic, clot internally and die. Not much we can do about it."

I can't stop thinking about it. I don't see this patient getting better, not in his condition, but I'm not the provider- I'm just a student.

He tries to eat lunch, but barely puts anything away.
When I leave, he's sleeping.

And now I'm at home, trying to study, and completely unnerved. Welcome to my first reality check.

It makes me even more determined to be the best nurse I can be, and subsequently, the best provider.
And the tears are still coming.

At Night, the Mosquitos Come.

The past three nights I haven't been able to sleep well. The sliding door to the balcony is a MUST to leave open, since SF has been having a heat wave (not as bad as a few weeks ago), and otherwise the air just stagnates. Apparently, somewhere on the property I live, mosquitos are breeding.
There is absolutely nothing more obnoxious than waking up with one of them whining in your ear. I don't care if it's on the river, or an urban mosquito, I don't like them. In fact, the Dalai Lama has even admitted to killing a few himself.
I don't feel so bad about the few I squished last night.

Sleep is a precious commodity, mostly because we're absorbing so much or studying early to late. On Wednesday there's this wonderful feeling of the week being over with, but then the reality that one has to get up at 5am (it keeps getting later every morning I have to do this) and be on the floor, ready to go by about 6:40, if you're lucky, is a stark reminder that oh yeah, I'm fighting for my sleep time. Some of us have to be ready at 6, in Palo Alto (not me, not yet).

We're 1/3 done with our first quarter, and have one more "first test" on Monday. It's been a nonstop onslaught of homework, testing, learning, practicing. It's awesome, definitely, but intense. They're not kidding. I think that the more hands-on patient care one has had, the easier it is to do this program - just being comfortable touching a patient is a skill that one learns by having to do it, constantly. And that's what we're here to do. To learn how to interact with patients, Do No Harm, and hopefully, do some good here and there.
Little victories mean a lot.
It's that intense. We're just constantly DOING.
I really like this MEPN program. I mean REALLY like it. Nothing academically has spoken to me like this before, and it really is perfect.

Last week during clinicals I got to watch a liver biopsy on a 37 year old transplant patient. His cousin had given him part of his liver. His family was super cool, and I enjoyed talking to them; however the biopsy nearly made me faint. I can watch someone bleeding out all orofices, but show me a 6-8 inch long needle (I'm not kidding, and I was told that was the small one), and I'm not okay. It's why I'm not a surgeon.

Speaking of surgeons... they're incredibly busy, and there are a few residents and attendings who will say hi or good morning, but for the most part, I have a joke to share:

Do you know what the difference between God and a doctor is?
*************************
God knows he's not a Doctor.

I'll leave you with that. I have to get going for another day of clinicals. We're still observing mostly, and today we have to pick one patient and know their history, diagnosis, discharge prognosis and care plan. No meds yet.

It's only Tuesday

The first week is in full swing. I am currently on the couch, not moving much, enjoying what little free time I have from day to day.

Our pathophysiology professor seems very nice, and talks very quietly. And yes, Pathos = suffering, for all of you who didn't know the greek roots of the word "pathology" - in that spirit, we have our first test next Wednesday. Yes, in our second week.

Our Intro to Professional Nursing class is fantastic. We have two professors teaching, both who are incredibly intelligent, and one who is a fireball of animation. I'm in stitches (no pun intended) whenever she lectures, and she makes us want to go to class. Sigh. Thank goodness we've got great instructors. I'd expect no less, but man, the charisma of these people who have developed our program, from the Dean all the way to the instructors to the students is off the charts.
Even though I'm a little tired, I have a smile on my face.

Today was our first clinical skills day, where we spent time learning how to wash our hands properly (15 seconds) and make beds with patients still in them. We also went over giving bed baths, and spent a good hour taking turns in the spotlight, explaining how to bathe a patient, and why it's so important. Good ice breaker, along with good information.

Tuesdays from now on will be spent driving to San Rafael, but today we met our CIs (clinical instructors) whom we will be answering to on Thursdays and Fridays from 7am-4pm, or earlier if placed at Stanford. I already dig my CI, Chuck, who seems really down-to-earth and happy to teach. I lucked out and am at UCSF this quarter, although I get my dose of commuting to Palo Alto in the winter. My fellow MEPN group are all people I know- one friend from Mills, one friend from around SF, and one person in my specialty. All students are in med-surg type wards: some are in trauma, some in geriatrics, some are in oncology, but it's all med-surg. I'm at Long Hospital, on floor 9, which should be super interesting - to quote from the UCSF website:

"Transplant: 9 Long is the unit where all of the kidney, pancreas, and liver transplants are cared for. UCSF is a Center for Excellence in Transplant Surgery, performing over 668 transplants a year."
-and-
"The Acute Hemodialysis Unit (AHU) on the 9th floor of Long Hospital provides dialysis/apheresis treatments to adult and pediatric inpatients."

Apparently we also get overflow patients other wards, such as Immunology/Oncology.

Clinicals should be interesting. We only have one day this week- Thursday, although usually it's Th/Fr.
Typical first quarter schedule:
Mon 8-4 class. Go home and read forever
Tuesday 9:30-4:30 clinical skills lab in San Rafael. Carpool, joke around, come home and read and collapse.
Wednesday: 9 or 10-4 class. Go home and read forever.
Thursday: 7a-4 or 5pm clinical. Go home and collapse.
Friday: 7am-4 or 5pm clinical. Drink a beer, go home, collapse.

Yep, it's only Tuesday.
Favorite word encountered so far: "blebbing" in pathophysiology. Say it 5 times fast without laughing. Go on, I dare you.
On to homework...
And tomorrow, we'll see what Pharmacology has in store.

Dis-Orientation

So, orientation happened. I felt oriented. I came home and completely fell asleep in the arms of my love, because I was exhausted from being talked at.

Some very cool things about orientation: the free breakfast and lunch that are *fantastic,* seeing all the cool people from your interview day who were outgoing and friendly, getting your clinical assignments and having some idea of where you'll be for the entire year. Actually being there. Lunch with a former MEPN (very informational). Bring your laptop; it makes things easier.

Not-so-cool: the reality of financial aid, trying to figure out how the hell you'll get to where you'll be for the next year, getting up at 6:30 after having a month of sleeping way past that, the insane influx of everyone trying to get their ID at the same time (hint for next year- do it at lunch, don't go at the 1-4pm time that's scheduled, because you'll be in line with 60 people).

Other Cool things: Bill, who will be a mainstay of sanity, brought me a little stuffed beaver named Wynona, after the Primus song and because she has been "gay square dancing" a few times with Bill. She's awesome. She even has a little pink necklace. I'll post a photo when I can. She lives in my bookbag now, and makes everyone laugh.

The slight confusion they talk about is true. It's just overwhelming. Be kind to yourself. And start getting sleep.