The ARRR N: adventures of a river guide UCSF MEPN, now on the way to her ACNP.

October, overwhelming.

2011-10-01T08:30:00.000-07:00

Healthy or paralyzing fear?

Depends on the day. This program is a huge step up in everything that we're doing, and I really love what I'm learning. The stark realization of responsibility hits me every 15 minutes or so and I find myself nearly panicking - then I remind myself that there are two years left and I'm just beginning this program, and somehow I head back into studying.

Yeah, it's exciting. Sometimes I look around while at UCSF and I can't believe I'm there. It's everything I've ever worked for, and I'm doing it.

So many changes in life- it's amazing what a mere 8 weeks will teach someone. Burning Man was pivotal for me in so many aspects; I loved being a med supervisor and really connected with a group of EMS personnel who are just as goofy and fun-loving as I am. They were people who listen to each others' stories, understand one another. I felt more at home than I have in a while. And the gifts that the Playa provided! I can't even begin to articulate my experiences from this year, because they were so profound. Returning home from Black Rock City, I felt as though my lessons continued, and I felt ready to embrace life in a way I haven't for a very long time. I felt alive again. I still feel that. And I knew some changes had to occur. Which brings me to: Will is most likely moving to LA, where his world, life, work exists. He travels all the time for work, which is great- he's awesome at what he does. But leaves me alone. A lot. I think he's been home at the most 10 days in a row this year. Yes, what does that mean? I'll deal with that later. I can't even begin with that one.

All I can say is that in this past year, I've been lonelier than ever. But that's about to change.

Suffice to say I'm glad I'm in school, where I can get lost in learning.

Here we go.

New, new, new.

2011-08-12T07:55:00.001-07:00

Everything is new. I'm getting inundated with emails from school for stuff I need for my Master's degree. I started a new job. I work days, mids, whatever I want and make a little more money. I'm in a new ED. New doctors. New system. New everything.

At Burning Man: new camp (we're not running a theme camp this year). New place to camp. New position in ESD- transitioning from volunteering to being really involved. Out there for two weeks- I've never done that. New, new, new.

A little overwhelming but it's going okay.

Reminding myself to take a timeout to breathe.

Anniversaries and such.

2011-08-06T11:35:00.000-07:00

That's the Iron Door Saloon, in Groveland, CA. It's the oldest bar in California, and you might recognize it as "that place I stop into on Highway 120 on the way to Yosemite." We Tuolumne River guides recognize it as "the closest place to get a beer" and "Karaoke Night" (aka Thursdays in the summer time).

It's also where Will and I met.

In fact, it's also where we had our first kiss.

August is full of anniversary stuff for us; for example, we first kissed on August 3rd. How do I remember that? Because our friend Chelsey had an epic birthday party that happened to fall on a karaoke night (Thursday) at the Iron Door Saloon, and it was amazing that we all were able to guide the next day. We took a group of 25-35 year old tech gurus from Chicago down the river on a two-day trip leaving the next morning, and it was probably one of the most memorable trips in my 15 years of guiding. Will wasn't on that trip, but we ran out of beer by 5pm (the rafting guests drank ALL of it by 5pm) and then ran out of wine by 6pm. So what did we do? Naturally, we used the satellite phone to call the ONE person we knew would be up for a mission: Will. He hiked in 4 handles of rum and 8 liters of mixer with his guitar and made it to our camp by 9pm. I remember the entire group cheering as they saw his headlamp bobbing down the trail from Groveland to Indian Creek on the Tuolumne. He then stayed and played songs until midnight, hiked out and worked a one-day trip (18 miles of river in one day), took out from the water with us AND was our bus driver due to his Class B license at the time.
Epic.
He's kind of awesome that way.
That was one of the coolest instances in our relationship

Also in August was our first trip to Burning Man, also known as Black Rock City, Nevada, also known as The Playa (not pronounced "player" but "plie-yah"). It's where we fell in love, it's where we got engaged, and we also got married at the temple there last year, dressed as Unicorns, by our friend and reverend "Pastor Prime" (get it- past her prime? nyuck nycuk nyuck).

See?

August was awesome.
And for those who might be wondering, October is our "default world" anniversary, where we got married in the state of California and made it all legal and stuff with our families.

September, however, will be tough for anniversaries.

What some of you may or may not know is that on Sept 24th of 2010, Will was supposed to be leaving for his bachelor party. It was a Friday. I was driving on Highway 80 towards Roseville, having decided to go check out lingerie and maybe go have a night with my girlfriends in Truckee.
Will called me, "Nicole, Paul is dead."
"What? Don't say that. It's not true."
"Nicole, he shot himself this morning. Justine found him."
I immediately pulled over on the highway and vomited.

Paul was Will's best friend, our best man, and was deeply in love with Justine.
I didn't blog about it last year because I didn't know what to say. I still don't. Paul was one of the most amazing people I knew: he was an expert river guide who, even with a below the knee amputation, could run faster down a river bank, could guide crazy Class V heck even Class VI rapids, and could do more than the average person ever dreamed of. He was larger than life. He was incredibly loving. I remember when he took me and Will aside and showed us the ring he was going to give Justine later that week, and the sparkle in his eyes, and how excited he was. I don't remember a Paul who was depressed. I don't remember a Paul who would ever have left this world intentionally.
Here's how I remember him (he's in the dark t-shirt, Will is closest):

We went to his funeral the weekend before our wedding.

Paul and Justine's wedding anniversary was October 11th. Ours is October 10th. We had kind of planned it that way, and had spoken about celebrating together over the course of our lives.
That's gone now.

It was horrible. It still is horrible. Nobody will ever know why. Many of us blame ourselves for not seeing something sooner.
Having to go forward with a major celebration of love when one is grieving is emotionally confusing. Trying to support Will in losing his best friend when I've lost a friend, too, is a balancing act. And then there's the fact that when I write about all of this, I feel like the vocabulary is lacking.
I feel selfish on so many levels- I wish we had a wedding that wasn't overshadowed by grief. We celebrated, but we were definitely subdued. I wish that Will had actually been able to go on his bachelor party- he's planned so many for other people and was so excited to have had one for himself. He deserved that.
And I wish Justine had Paul back. She is one of the most amazing women I've ever met, and her grace in all of this chaos has been impeccable. I cannot imagine the hell she has been through.
And then I know my feelings and my grief, and yet, I still feel selfish for wishing it had never happened.
But it did happen. And I'm angry and sad and mad at myself for being angry, and feel powerless in the wake of all of this death.
And I can see how much it's affected our relationship (Will and I) over the past year. To say that "Things have been hard" is an understatement.
And I don't know how any relationship can survive something like that.

Sometimes I still have trouble taking care of people who are 5150'd in the ER. I had a woman wake up, intubated, after trying to overdose on benzodiazapines, and when she realized her husband was there, she started crying out of shame for what she had done and relief that she was alive. She got help.

I wish I could have helped my friend.

So, yeah. Anniversaries. Some are beautiful and meant to be celebrated. And some are laced with incredible sadness. This time last year, my friend was still alive. This time last year, Will's best friend was still alive.

People can throw quotes at you all day long and can offer hugs and reassurance, but nothing, NOTHING takes the place of that person in your heart.

This year at Burning Man we will have the Temple of Transition. I have a lot to bring to it, and I know where my heart will be as I watch it fall.

Teaching.

2011-07-28T10:45:00.000-07:00

That photo is off my boat on the Grand Canyon, which was a sweet trip.

Full circle. Two years after starting the MEPN program, I'm now lucky enough and crazy enough to help teach new MEPNs. I'm river guiding rarely, working as a nurse in the Emergency Department a LOT, and teaching to really fill my soul.

I never knew how much I'd love teaching.

I also never knew how frightened I'd be to re-enter the Master's portion of this program.

So, I had to leave my Level 1 Trauma Center job in order to teach, so now I work at a Level 2 Trauma Center, hopefully going to be splitting a dual appointment with the Emergency Department and perhaps the PICC/IV team. Days, thankfully. I work DAYS. Sweet.

Night shift made me insane.
But that's not what I'm here to blog about.

I wanted to talk about teaching. It's been challenging, for sure. I watch the new students get so excited about the smallest part of nursing they get to experience. I watch their faces light up when they help a patient make a small achievement for the day- and for me, that's the real reward. Sometimes they get so lost in details that I could scream (oh, the questions), but I know it's part of their learning process and I want them to ask, ask, ask.

Their passion is amazing.

So we were talking about inserting nasogastric tubes the other day, and one student asked me, "What if they bleed? Or what if you hurt the person while you're doing this procedure?"
To which I replied, "Well, sometimes you do hurt people - I mean, it's not comfortable. Do you harm them? No. But you do hurt them. You aren't always doing something nice - sometimes you're doing something that is really uncomfortable."

She stated, "Wow. You must kinda lose some of that connection, you know? I mean, ER nurses must learn how to not care."

I blinked. And said, "No, you never stop caring. If you stop caring, you leave nursing. You just learn to differentiate between what's actually harmful and what's necessary for healing. I've refused to do things before. People have the right to say no. And you get used to how procedures go. Not every procedure goes perfectly every time. You just do your best."

And I realized I meant that. I could have told her about my patient the other day whose heart stopped mid sentence and was a DNR, and how even though I was still taking care of patients that day, I stepped into the room with the family and cried for 15 minutes with them. And that I still think about her.
I could tell her that I walked into a room with an intubated patient, noticed her BP was sky-high and titrated up her sedation and spoke to her in soothing tones, and watched her heart rate and BP drop to a more normal zone. I could tell her that I never say anything bad about my patient even if they're sedated, because I assume they can hear me, and my place isn't to judge.
I could tell her that sometimes I judge anyway, and I have to shove my judgment aside. I'm human, and people do stupid things, for sure- but how many times have I done something dumb? Nobody deserves to get hurt.
I could tell her that every time I feel like I hurt someone I cringe inside.
I could tell her that I give 110% to people while I'm there, because, well, that's my job and I love what I do.
I could relate the time I had a guy who learned he was probably never going to walk again, and how I held his hand and my friend Jen held his other hand because he wasn't sure if his child was alive, and how we both stood there and cried with him for an hour, because we had the time to give and we could be there and he said, "Please, please don't let me be alone." And dammit, we weren't going to let him be alone that night.

I couldn't do this job if I didn't care.

Inconsistencies.

2011-04-01T20:53:00.000-07:00

I have to say, writing at all in this blog is challenging for a billion reasons, but mostly because *I'm* really not that interesting.
My patients, however, are.
And there's this little law that keeps me from really writing about them.
So I have to get creative. Which I guess is the point.

A little background: still on night shift (hell), married, now cat sitting for a friend (and they are adorable).

And that's life.

"Because you don't suck."

2010-11-20T08:30:00.000-08:00

Ok, this morning, I was walking towards my car with another ER nurse friend of mine, someone I really just love because she's a great nurse and actually genuinely kind.
And the subject of double time came up -
we get double time pay when we stay over past our 12 hour shift (rocks, seriously). And she made a comment, and I commented back that my pay was not that much.
And she said, "Why? That's BS!"
And I reminded her:
"Well, they started me at the lowest pay possible. I've only been a nurse for 17 months. I'm a baby."

And she stopped, and looked at me, and said, "You know, I forget that, because you don't suck. You're, like, really on top of your sh*t." (that word is obviously "shot" since I work in a trauma center). "You know how some new nurses just suck horribly? You actually are really smart, and everyone likes working with you. I forget that you're new. You're, like, not really new. You're quasi-new. Some people never get it, and you totally get it."

I blushed. I think I muttered something inane and ran towards my car, waving good-bye/good morning.

But I secretly really liked that compliment.
I am scared of being a sucky nurse. And I'm glad that at least some of my co-workers don't perceive me that way, because honestly, I really care.
So, that was kind of awesome.

No, really

2010-11-01T03:47:00.000-07:00

Yeah, now it's really been a while. And why?
Because no matter what anyone tells you, it all comes down to the fact that night shift... TRULY SUCKS.
Yes, the camaraderie is amazing. Yes, you will learn more than you would on day shift. Yes, you have to troubleshoot for yourself, and doggone it, it's good for you when you talk to salty old nurses who can reminisce about how tough it was to have a night shift and be so stranded with few resources and new interns and new residents and oh my god we're gonna hurt these 8 patients I had to take care of in the snow uphill but....
it all comes down to:
Night shift sucks. Ass.
It creates good bonding, and to those who are naturally night people? Good on' ya. Please keep our world turning.
I remember being up before sunrise. Now I stay up until 11am sometimes. And it makes me feel weird.

But overall, it's good for me. Or so I keep telling myself. So, until the holidays are past, I am going to keep a positive attitude. I have my dream job. I am working in a level 1 UC trauma center that gives me tuition discount etc...
I see things that most people will never see (Rheumatic Fever? Really? Seriously?)
I see cutting edge treatment. I've run a gurney to the OR with a surgeon's hand in someone's heart, holding an Aorta together. I've seen dead people come back from a code. I've seen trauma unlike anything I could imagine. And I'm still here.

And my husband is by my side. So, that speaks for itself.

Been a while.

2010-08-15T20:46:00.000-07:00

It's been a while. There have been so many life changes, I can't even begin to start writing about them. Apologies to those who have left comments- when I write, I really like to spend time focusing on writing, and given a new job for both of us, a billion life changes, and a wedding to plan, I'm stretched thin.

Ok, the short version:

Will is now the CTO (chief technical officer) of a 3-D television company.

I just got my dream job, that I've wanted since I decided I was going to nursing school:
I am now working at UC Davis medical center in the Emergency Dept. We're a Level 1 Trauma center, which means: teaching hospital, sicker patients, and total insanity. Add the fact that the ED is moving to a 50,000 square foot brand new building in about 1.5 months, and there is total utter chaos.

Keep in mind I'm following HIPAA when I discuss patient stuff:

In the past month on orientation at Davis I've done CPR on about 10 people.
None of them lived.

I'm in process of filling out a ton of competencies. Our orientation binder is about the same thickness as an entire quarter's class. There are 10 new nurses orienting together, and I think they just added 5 more. There will be another 10 coming in soon.

As far as CPR and codes/determining death go:
The really cool thing is that not only do we use two different leads, we actually use ultrasound on the heart to see if there's any activity at all. If there is, we take a next step (still learning what that is, depending on the person and the attending physician's preference).
For those of you who may not know, in order for a physician to pronounce death, the patient has to have asystole in two different leads/EKG perspectives on the heart, which ensures that the patient really is dead. It's a failsafe. Using ultrasound is even more accurate. It's really cool how far they'll go to work to save someone.

I've driven a gurney at Mach 3 to the OR with blood dripping behind it a-la-Hansel-and-Gretel-trail, with a surgeon's hand in someone's chest holding their dissected aorta together while three nurses were hanging blood as fast as they could to keep that person alive. At least you can really say we tried. No, that person didn't make it.
The twisted thing is that all I could think about was BBQ afterward. I attribute it to the rib spreaders. What? I mean, I know, it's twisted. I warned you. This blog isn't always pretty, and we EMS folks are a little... different. Thank goodness.

I've seen someone pronounced dead after being coded for an hour. Asystole on two leads on two different monitors, ultrasound of the heart showed no activity. Full on "Time of Death: blah blah blah."
Somehow, a few minutes later, this person was in NSR (normal sinus rhythm: ie, their heart was beating. Normally. This kind of thing ONLY happens in soap operas, folks).
Nobody has seen anything like that in their entire career.

I've seen all sorts of other stuff. Crepitus (Sub-cutaneous air) from a pneumothorax, some really sick people in general, lots of intubations... it's a mad, mad place.

I've seen imminent delivery. That's actually kind of happy and fun, but messy.

The nurses I work with, for the most part, are some of the most intelligent, welcoming folks I've met. We are expected to have a vast array of knowledge, and to be able to anticipate a lot of interventions. Many of them have advanced degrees. Half of them have over 15 years of experience. I am a baby in comparison.

Nobody could ever be on facebook here. There's no way in hell you could do anything but try to keep your patients alive. Especially when 4 people come in with CPR in progress, the Resuscitation Room nurses need help, and your patient's blood pressure is dropping and you need help, too. It's insane.
And I love it.

I start nights again this week, which I'm not looking forward to, but at least I know what to expect.

On my off days, I'm back in my Sacramento routine: outrigger canoe paddling, cycling long distances on the American River Bike Trail, and I have yet to visit my old Bikram Yoga studio.
Our new place is infinitely better than any of our old apartments. It's a 2.5/1.5 with tons of storage, a backyard, a garage, a basement, and a rose garden in front. Our landlady is super cool and likes to share a glass of wine with me on the back porch.
Life is pretty good.

Assaulted or A-peppered? Happy Nurses' Week.

2010-05-09T17:59:00.000-07:00

I mean seriously, come on.

There are nights (actually, I guess mornings) when I leave the ER and I wonder if people show up just to fuck with the nurses.

Since starting work as an ER nurse, I've been kicked, grabbed, clawed at (I understood that one, though- 90 year old on whom I was inserting a Foley catheter), spit on, yelled at, called every name and *then* some, pushed, and had someone very nearly injure my thumb. And that's just from the patients.
That's not including patient's families.
Let's not forget the MDs who sometimes lose their cool, because even though we're part of the healthcare team, we're still "just a nurse" to some of them.

I've seen tricks, from fake seizures, to "I'm suicidal" right before discharge of a homeless person (because they have to stay on an 8 hour hold after that until the Psych team evaluates them, so they have a bed to sleep in), to "I can't walk" - until that person wants to smoke outside, to "I have 10/10 abdominal pain... can I get a meal tray please?"

And yet, most of the time we just take it all in stride and brush off the mean comments, the yelling, the snide remarks, and know in our hearts that we do our best to care for people who really, really need it.

And sometimes, people say "thank you." You have no idea how much I appreciate those words.
And sometimes we fuck up, like all humans. Hopefully they're small f'ups.

Last night, I had a *patient with advanced cancer (*NB reader, I will reiterate, all patient stories are changed to comply with HIPAA). He was grouchy because he had been there a while, had no white blood cells to speak of, and we had been promising him a room for hours. And then, of course, I missed his portacath when trying to access it. I've never missed before. I was about halfway in and the Huber needle bent, which I've never experienced, which honestly, just sucked. And when you have an already grouchy patient, who has a real reason to be grouchy, who is actually very sick, and you're trying your damndest to do something good for them and you fail? Well, you feel very much like you suck. I had another nurse re-try and he was successful, and fortunately we got that person upstairs to a more comfortable bed, but yowza, if looks were lasers- I felt like he mustered his last bit of energy to shine some anger on me. I understood, but I had been doing a lot behind-the-scenes to help him out, regarding pain management, paging physicians, and getting the antibiotics and blood going that he needed to help make him feel better. It wasn't so much the missing the portacath, mind you - it's probably the knowledge of impending death, pain, feeling like hell (Hemoglobin and Hematocrit of 7.2 and 21.5, respectively, which SUCKS), and having everyone tell him "soon, you'll get a bed" for four hours... and then me missing the portacath.
And I felt awful. I had worked on his inpatient orders while taking care of three other very very sick people- my least acute patient had an open compound fracture (splinted in place) and was going to surgery in a few hours - and understandably had pain control issues, which I was also having to manage every 20 minutes - and trying to get a doctor to increase an order for dilaudid ("no NOT 0.4mg, we gave him 4mg today. Yes. What?? You want to start with 0.4? Did you see his arm? Okay. I can guarantee you're going to be paged all night. Can you increase it to 1mg q 2 hours?"). My other two were 1) psychological issues with COPD (who went home after her breathing improved greatly) and 2) someone with a BP of 225/115 with blurry vision. Yeah.
And just when it was all almost under control, we get someone who overdosed in to my section- not my patient, but when that happens, we all help out because it's a heavy, heavy workup.

We had an assault patient show up as well. It was 4am, and he was a bit difficult to deal with, and the doc was getting frustrated. The doc asked, "So what did he tell you about being assaulted? Do you think he really was?"
I deadpanned, "No, he was actually a-peppered."
At 4am, that was really funny, and decompressed some of the insanity of the night.

Later that night (or early morning), my mentally ill COPD patient came back to scream at us and tell us that we're all incompetent, and then ask if she could watch TV. She started holding her breath to show us how short of breath she was (yes, after screaming). It was an incredible act, and I just shook my head. She pointed at me and the doctor to say that we sent her to the "Clinic hospital" and we were incompetent. Um, yep, I gave her info on a free clinic where she could follow up for managing COPD and her behavioral issues at her request, and made sure she had directions and a bus token. Apparently, she was angry that they weren't open at 5am on Sunday morning. Sigh.
It was almost as good as the girl in triage who I watched shove her finger down her throat to vomit, and then tell us she had nausea and vomiting. Classic.
I had no energy to say anything. At 6am after working all night and taking care of everything under the sun, I just have no patience for that kind of bullshit.

So, my point being: Happy Nurses' Week.
Someone, a friend of mine who is almost an RN and just finishing nursing school, said she thought that we have "very little power and great responsibility."
I absolutely disagree.
I think with great power comes great responsibility.
I know with absolute certainty that I do my very best every day for my patients, even if I shake my head sometimes.
We have the power to make people feel very comfortable in times of great distress, and sometimes in times of great embarrassment.
We have full on Jedi-mind power to decompress a lot of situations.
We have the ability to mostly let things roll - water off a duck's back, my friends.
We have the trust of both patients and physicians. And of our colleagues.

And we deal with a lot of shit. Figuratively and literally.
So, point being, next time you see a nurse, make his or her day.
Just say, "Thank you."

Spring Cleaning

2010-03-30T19:32:00.001-07:00

Those crowbars are on the floor of Will's grandpa's kitchen. We were pulling out drywall and I put the bars down and *gasp* there it was, love in the middle of us pulling down the walls. Kind of awesome.

Between working night shift and planning a wedding, writing has taken a back burner to life lately. Some fun things have happened: I found my digital camera, although it's not charged, so I can share more fun photos of cool things, like the most awesomest pen light EVAR in the shape of a killer whale that my friend Katie sent me as a thank you- and my little kiddo patients love it. *Happy Dance!*

Wedding plans are deep underway: venue, bridesmaids all picked and dresses purchased, DJ, Photographer, on to cake tasting. The worst part is the list of invitations. We have been *agonizing* over the invites. Anyone who's been a bride knows this pain.
Sheesh.

I've also been weeding out sources of stress. This past month, I've gone 50 days without any alcohol (I know, can you believe it?), which was a real eye-opener as far as stress relief goes. Many of us use alcohol to de-stress, and I've had to use other venues, such as walks, yoga, stretching, meditation, tea, art, and of course, shoe shopping. I've had more massages in the past month than I have in the past year. There's been some balance restored. Much needed.
I have also done some work examining (with help) people who have used me in the past or who I have allowed to cross my boundaries - this list includes folks from college to people I work with occasionally, to even patients, and recognizing how much I tolerate without speaking up has lead me to be a lot healthier- and now I let people know immediately if something bugs me. I still have to say in some cases, "If you can't say something nice..." is a good rule, but for the most part, I'm not rolling over on my back anymore.

The smell in the air and the wind and rain has been reminding me of river season. I had a moment, driving up the central valley, where I just flashed back to the first time I drove into a river canyon, and that familiar feeling of love and excitement comes back to me. I can't wait to put my paddle in the water.

That's all for now. Working to get a per diem job, taking another year out from UCSF so I can really have the experience to help me as an expert in the future, and doing work on maintaining and constructing good boundaries.

And I'm also saving up for shoes. Oh my god, shoes.

Vampire Hours.

2010-01-26T01:02:00.000-08:00

It's been a while since I've posted, which is partly due to the holidays, and partly due to the fact that I've been on night shift for the past month.

I feel like a vampire.

A couple of things have been developing. For one, I'm actually on my own as an RN next week, which I'm simultaneously excited and terrified for- on one hand, I won't have someone looking at everything I do; on the other hand I won't have someone checking up to make sure I did things right.

The night crew is so amazing at helping each other out with things in the ER, so I have to say I have seriously enjoyed working with everyone all night. The camaraderie is beyond anything I've seen.

The sleep deprivation has been difficult, but I'm lucky enough to be able to sleep between the hours of 8a-4p. Wild. This schedule all stops next week when I work a more normal 1200-0030, or noon to midnight in regular time.

Other wild things: We've had Tornadoes here in SoCal, snow, rain, thunder. I love it.
Today I also had my first experience at Disneyland as a SoCal resident. All I have to say is that "Yo-ho, Yo-ho A Pirate's Life for me" never gets old.

Oh and wedding preparations. More to come with that.

Learning.

2009-12-04T00:28:00.000-08:00

Every day I learn, I am humbled by how much more there is to know.
Here's a sample:

I've learned that fake seizures are indeed, obnoxious.

I've learned that asking a parent, "How are you doing?" when their child is sick and in your care goes a really long way.

I've learned that more people should speak Spanish in California.

I've learned not to trust other peoples' charting and to make my own assessment.

I've learned to try for the "tough stick."

I've learned that no matter your religion, there's a special place in hell for people who hit-and-run 80 year old grandma crossing the street to go to church.

I've learned to go to the doctor, even if he's a jerk, because the time you go to him and it's really a big deal, you earn more respect than you ever imagined.

I've learned to never let it go to your head.

I've learned that I will have days where I seriously screw up, and am grateful that nobody is hurt. (Knock on wood).

I've learned that I love what I do.

I've watched other people sit on their asses and not help out when push comes to shove, and I will never be like that.

I've learned that if you tell me the exact amount of pain medication you need, where to start your IV, and that you're allergic to all meds except ativan and dilaudid, then I consider you a GOMER (Get. Out. Of. My. ER.), and I never thought I'd ever feel that way towards anyone. And if you ask me for a meal tray and then tell me you're suicidal after I refuse because I'm waiting for your lab tests? Then you have incurred my wrath and I resent paying taxes for your visit. And I especially resent you if your ring the call light 40 times while I'm in a pediatric code next door.
See this youtube video, it is so illustrative of the crap I deal with: http://www.youtube.com/watch?v=_m64cy1MMPg&feature=related

I've learned that you cannot, no matter what, give more than 10mEq of Potassium per hour or you will cause a dysrythmia. And I have not done so, thankfully.

I've learned that if you call a nurse "honey," s/he will cringe. And will lag at getting what you need.

I've learned that a good charge nurse is really awesome.

I've learned that even a jerk of a doc can be a really awesome diagnostician.

I've learned that when the doctor says stop CPR, you stop. And you realize that you've done all you can.

I've learned that when you start an IV on a kid, you had better damn well get it the first time, but sometimes you don't, and that's okay.

I've learned that really, everyone who is sick and in the ER is afraid, and if you honor that, then you have a way better chance of connecting and understanding what's going on with your patients.

I've learned that the little things really go a long way.

I've learned that I have a helluva lot more to learn.

Hello, Backbone, "How you doin?"

2009-11-09T00:54:00.000-08:00

Thank you ER, for giving me something that I sometimes lack: a spine.
It's been helpful in more ways than just nursing.

I've gained clarity that I've really needed.

Things that I've lost sight of.

In the ER: I am now able to stand up for myself. I know when to ignore, I am better able to figure out when to question, I'm more of an advocate for my patients.

In personal life: I have always been able to stand up for myself. I am angered when people underestimate me. Being told that I'm malleable and "easily influenced" even if someone feels that way tells me that they severely underestimate me and they seriously overestimate themselves. I am much stronger than most people know. Part of that is from reading the "Ancient Art of War," which allowed me to keep my guard up, no matter what the situation. I am quiet when confronted in interpersonal interaction, which is often mistaken for weakness.
And I am certainly strong, in ways people don't even imagine.

Will is one of the people who has never underestimated me, which is why I love him so much.
In any case, I am happy to have found my spine again. And I am deeply happy that Will is back and here with me.
This time is a special one. I am living day by day, happily reveling in rejoining and rejoicing.

Intensity, and a Labor of Love

2009-10-20T21:26:00.000-07:00

The ER is getting better.
The above image is sunrise at Lee's Ferry on the Grand Canyon.
Being a full-time Canyon guide is on my "Bucket List," and although I've rowed it and guided it, I'm not a full-time guide with even 20 trips under my belt.
But my heart is still there.

There are certain things in your life that grab hold of your presence so intensely that you know immediately if your heart belongs there or not.
Nursing, and the experiences I have every day in my job, validates this more than anything.

It's so much a labor of love. I read my friends' blogs and I realize more and more how much our time in nursing school was dedicated to really loving people. I see it every day in my ER when I take the extra second to be kind to somebody and they thank me.
We were raised well.

Love is giving freely. "Love is patient, love is kind. It does not envy, it is not proud..." one quote from the Bible that I can hang with (1st Corinthians 13 something, forgive the absent mind of the Catholic schoolgirl).

The river has my heart and soul.
I am deciding whether I can give it elsewhere. My patients get my heart every day. I am someone who loves deeply. I have to recognize this and love it in myself.
I have a capacity to love many people. I also have to recognize and embrace this fact.

Just like I embrace the sunrise over the river.
Just like I embrace my dreams and goals.
Everything we do leads us to something better and more amazing for ourselves. I truly believe this fact.
And now, I just need to live it.

Climbing Behind a Waterfall (an allegorical anectdote)

2009-10-07T15:18:00.000-07:00

This photo was taken in September of 2004, while I was on a Grand Canyon trip. This exact spot is called "Elves' Chasm," and it truly looks like a place where you might expect little people to pop out of the crevices around you. The waterfall is stunning, and you can crawl up behind it and jump into the shimmering, clear pool below you. There are seven pools you can explore, each one more dazzling and more difficult to access- in fact, I know of someone who fell to their death while trying to climb to the top pool (that's another story). There is no safety net. There is only your impetus to explore, and your awareness of your actions.

That's how I feel right now.
Acutely. Aware.
Of all of these things.

Those who know me know that I have an incredible fear of heights, to the point that even bouldering in a climbing gym terrifies me. I've made it to the base of the cables on Half Dome and couldn't bring myself to go further.

So the fact that I took this picture is actually very sacred and telling to me. Even though I was afraid to climb behind that falls, I did so, and I was rewarded with this amazing, dynamic view.
And guess what?
In the end, it wasn't that bad.
And guess what else?
I jumped.

I jumped into that clear blue pool below and laughed and cried and was given hugs and then I climbed up to the next pool, and the next pool, and the next one. I haven't been to the uppermost one because it was just too treacherous at the time and we didn't have the equipment to get there. But I pushed my boundaries, explored, and was rewarded with an awareness of a place that I will never forget, and one that I long for.

There are pieces of me that I have missed deeply, and I am reconnecting with them now. I feel like I've been neglecting aspects of myself that are central to who I am.
And I'm ready to climb a little bit.

Nursing is like that every day, and yes, I'm talking about nursing and stepping out on a limb and being afraid of what I do and the consequences that my actions have for others, but I'm also not talking about nursing.

I'm talking about life.
I'm talking about love.
I'm talking about living.

My meditation lately has been:
Meditating on the idea that courage comes from love (coeur, corazón), and fear comes from the unknown. I embrace unknowns; I choose courage.

This saying has been one of mine since the end of high school. It has every bit of the same importance right now in my life.

We must be gentle and kind to one another, and help each other explore. We must help each other reach those pools, those places that are difficult to access, but open us up to a world of beauty. It requires trust, faith, and patience.
Regardless of if it's nursing, or if it's vulnerability, or if it's acknowledging each other and ourselves for who we truly are, and loving that especially.

That's all.
Oh yeah, and here's Elves' looking up at the waterfall (different perspective is always good)

Bunnies have more fun.

2009-09-24T19:04:00.000-07:00

No, really. That's me, at Symbiosis festival, doing medical work.
It was a pleasant relief from being in the ER everyday and having my ego shattered.
A lot has happened since I last blogged.
For one, I'm engaged. Awesomeness and love.
For two, I'm taking steps towards being less afraid of other things in my life. I can't elaborate here, but wow when you are open, life hands you some cool surprises. Some of those are worth waiting a long time for, and I am incredibly struck to the core by what can happen when we manifest our intentions.
For three, I feel like I suck as an ER nurse, it's okay. I've decided my work environment is destroying my soul, but I'm learning a lot, so I gotta suck it up and go with it.
Hopefully all will be well.

That's the news for now.
Aside from pushing Epi IV, which I'm sure I'll repeat.

Stay cool California. Or wherever you are.

Unicorns and Rainbows and such.

2009-08-16T14:54:00.001-07:00

I write a lot about nursing, and have written some about rivers, mostly because that's what my life has consisted of.

But now I'm gonna write about Unicorns.

Since I was a kid, I loved Unicorns. And now that Burning Man is coming up, we have actually created the Unicorn Ranch, which is a place for special hard-to-find people to be found. Maybe. If we like you.

It definitely will be serving pink fizzy drinks.

Watch for updates on our awesome camp. My sister and I are painting the artwork for it, so we're having fun with that. Will is getting an extra dome, and we have trampolines.
If you live in a cave, and don't know what Burning Man is, go here:
www.burningman.com

I can't explain it to you. For those of you who know, but haven't been, you need to come.
For those of you who know it was better next year... I can't wait to give you dusty hugs!

Adventures in Big Emergencies.

2009-08-05T06:04:00.000-07:00

Yesterday was actually pretty good, sorta. I missed a cardioversion which went on just after shift change (8:00pm), but I was exhausted. The ER is either going to kill all love and sympathy I have for humanity, or make it grow, or both.

The morning was pretty mellow, basic, a few definitely emergent-but-not-life-threatening things happening, and then all of a sudden, things heated up.
Within an hour of each other, we received a stroke patient, a patient having a bigtime cardiac arrhythmia, and then someone who was pretty septic with dangerously low blood pressure, out of it, and was pretty much circling the drain.
3 patients, three real emergencies. Ready, GO!

Sigh. When starting an IV on my cardiac patient, I didn't put the best pressure on his vein, so he bled a little bit (not a lot), but a little. His BP was really REALLY high, too. And he was scared.
And I will tell you this:
If you're a new nurse or a nursing student, listen to me carefully:
ALWAYS give the patient the call button before you leave the room. Even if they don't use it, they cannot be (as) upset with you if they have a way to get in touch with you.

Someone who was doing a test told him when he asked for one of us (literally 2 minutes after he had been stabilized and when we had just finished drawing blood and left the room to send it) that he would be lucky if someone actually came. First of all, that attitude is BULLSH*T, and secondly it's not true.
So he peed in the bed instead of calling and asking for a urinal or a bedside commode.
If he had the call light, he could have called for me or another nurse. So, that's the call light issue. Oh yeah, and this patient was relatively young.
I guess later he also figured out I was newer and was upset - apparently about the blood that leaked from his vein when we were getting his IV in. On the up side, I noticed that his O2 sat had dropped when he told me he felt confused, I figured out, "Oh hey, maybe it's because your oxygen is low and you need just a little bit. Sweet." On the down side, later that day, I also watched communication breakdown happen with him (and with me! I love it when people make major decisions about a patient and don't tell the nurses). It was a recipe for disaster, but the patient is okay, and that's what counts, right? Sigh.
Part of me felt like, "Wow, I totally understand how this person is frustrated," and the other part of me felt like, "Um, we just saved your life. We have 4 other super acute patients and I'm doing my best to chase down the doctor to make sure you're ok. Couldya throw a thank you in there somewhere?"

Be good to your hearts, folks:

Our stroke patient had a whole 'nother story as well, but that one involved a good catch by me: "Wait a sec, we can't give this med- the blood pressure is sky high but the heart rate is under 60, we need a different one...." and some love towards the folks upstairs to get them to admit our patient with a super high BP.
The one circling the drain- well, when we get people that sick, our ER will drop nurses to 1:1 ratio, so that we function like a mini-ICU until people get stabilized. That works really well.

So, I still feel slow, my skills are slowly coming back to me, and for the most part, I'm getting it. It's week 4 for me in the ER, so I'd hope so. I'm glad I have another 20 to go before I'm considered a full nurse.

Some people are stronger than you think...

2009-07-31T21:02:00.000-07:00

Every day is a new set of amazing stories. I see so many different people in a day, and I'm amazed at what I get to learn, see and do.

Today was a really good day. In fact, this week has been a lot better.
I actually have the ability to chart on patients, I know where stuff is in the Pyxis (the medication machine), and my IV start scorecard has improved drastically. Like I'm at 80% now - I'm just working on stopping the bleeding after I insert the catheter.

Tentatively, I'm starting to feel like a *real* nurse. Sorta.
I took on two patients on my own today (the standard is 3 to 4), and I'm getting the rhythm of it. The most awesome thing about the ER is that for the most part, the nurses and the docs really help each other out. The teamwork is stellar. I've learned which nurses will leave you 4 straight caths and bloodwork to do at the end of their shift, which ones spend more time freaking out than working, and which ones see that you have a new patient and will help your other ones to the bathroom or draw the blood or help with a procedure when you're swamped. There are more of the helpful than the selfish ones in the ER, and that makes me happy.

This week has also been full of good lessons.
A 90+ year old man attempted to break my thumb today. He was confused, ripping out lines, his oxygen levels were low, and we had inserted a Foley catheter. Poor guy. I think I'd try to break someone's thumb if someone came at me with a Foley, too.
In any case, of course it came at the time that 1) we were supposed to take him upstairs to his med-surge floor on a heart monitor (and he didn't want the lines on him), 2) I had 3 other things to do for a patient going to CT scan who was worried she had cancer, and 3) I had to pee really bad (number 3 being the least important).
What do you do with someone who does that?
Me: "Hey that is NOT okay. You are hurting me. Let me go NOW." I grabbed his wrist, bent it enough to loosen his grip. I am acutely aware that I cannot hurt my patient.
Him: "I don't care if I hurt you. I don't like being here."
He releases his grip.
I sigh. I don't blame him. He's a DNI/DNR, and his blood pressure is sky high, his heart is working at 30%, and half the time he doesn't know where he is, and when he does, he's frustrated because he can't move very well.
We still got an order for Ativan to calm him down. When he tried to pull out his Foley (which sits in the bladder with an inflated balloon keeping it from slipping out) and his IVs, we had to. He was hurting himself.
And my thumb still hurts. But both of us are intact.

Yesterday I had my first violent patient as well. He called me every name in the book - and I told him to stop, that he had no right to be abusive towards me, or anyone else when we're trying to help him.
He fired me as his nurse.
It all started over a lost glove. Apparently the glove was more important than anything else, including the pain he had reported on admission.
The clincher was when he called the very large, formidable African-American security guard a "stupid, fat, n****r." You could have heard a pin drop. I think the patients all gasped and stopped vomiting. All of our jaws dropped. He continued to be belligerent, and demanded to leave. The patient was escorted out by numerous security guards. He obviously had some other major psych issues, but he was threatening the nurses, threatening security, and he swore at another patient. It was nuts. And a good lesson. I tried really hard to talk him down, and so did other nurses, and so did the Doctors and you know what?
It just didn't work. He signed out AMA, cursing all of us for losing his glove. It's the first time I really felt a sense of "good riddance." I feel sorry for him, and if he came back I'd try to help him, but there's a point where you have to cut off the kindness. I reached it.
The funny thing is that I don't think he even had gloves to begin with. It was a surreal experience.

And today, I had so many different people with different issues, it was amazing. From vehicle trauma (trauma!) to heart problems to a possible aneurysm, to Lupus flare-ups, to gallbladder attacks, to insect bites to Septic Shock with some very special circumstances... holy crap.

Kind of like nursing school, except - holy shit - it's real. I'm responsible. For people.

You can bet your sweet ass I'm checking every single medication. Is Vanco compatible with NS 0.9%? Is Toradol? How about Diphenhydramine? How much Fentanyl do you want to give IVP - his pulse is only 58? Hey Doc, you wrote the order for Morphine IM. Did you want it IM or IVP like you told me? Can you change that order?
These are the questions I'm asking constantly. I'm super anal about the meds. The seasoned nurses think it's cute, and they also respect it.
The other thing I'm stoked on is the critical thinking skills we got from UCSF. I can look at labs and have some sense of what's going on with a patient. I know where to look for info on Up-To-Date. It helps me anticipate what's coming, and it really helps in the ED.
I'm really grateful for our assessment skills.

Emergency. My dream. I still can't believe I'm here.
And you know what my feeling is at the end of the day?
I *really* love my job.

All Thumbs

2009-07-25T09:40:00.000-07:00

First of all, I am totally lovin' the Emergency Department (yes, it's a *department* not a *Room* - so when I say ED, you know what I mean).

I have seen so much cool stuff in the past two weeks, and I feel really fortunate to be where I'm at.
BUT
I also feel completely bass-ackwards. Somehow, between the end of nursing school and now, I lost all ability to start an IV. In fact, yesterday, I was the anti-IV starter. I blew the most perfect vein I've ever seen, and I have no idea why it was one of those days. It just was.
The nurses I work with have been super nice, "Oh, don't worry, it's ok, we miss too sometimes." Oh yeah? You guys miss on the 99 year old. I missed on the healthy person with an antecubital beauty the size of the Mississippi river.
Ack.

Sigh.
And with precepting, I kinda feel like I'm in nursing school again, except I can actually sign off on insulin, heparin, and narcotics. I *just* got my ability to chart yesterday, and I still don't have access to the Pyxis. I am about 70% able to help patients as far as logistics go. That's frustrating. And I still don't know where things are.

And I miss my MEPN friends. I am finally making some new ones here, but it's tough, you know?

Growing, growing, growing.

Bites, car accidents and emboli, Oh my!

2009-07-16T21:45:00.000-07:00

Today was wild. All information has been changed to conform to HIPAA.

I walked in to a new place, with my nurse educator on vacation, which she had told me would be the case. Not a problem. I was paired with an AWESOME nurse, also named Nicole.

Holy crap today was busy.

Pulmonary Embolus, or more specifically, R/O pulmonary embolism, fit the description of one of our first patients of the day. A 30 year old young woman, into exercising, with chest pain had a D-Dimer level of 5500. HUGE. The cutoff for a negative is <500.
Her CT scan showed some interesting stuff, but no clot, so we did what we could to keep her comfortable.

15 year old girl kicks the dog dish and gets bitten. Sucks. Maybe we don't kick things at the dog anymore?

Pneumothorax took the cake though. The Chest X Ray (CXR in medical abbreviation speak)
was amazing! I asked, "um, what's wrong with the left lung?" and the doc looked at me and said, "Wow! Yep, that's a pneumothorax." And all of a sudden a bunch of surgeons were in our ER and the patient was on a gurney, and I was helping the surgeons with the insertion, and I was silently thanking Pam for all of her lectures on chest tubes since I immediately knew how to set up the Pleur-Evac device. A pneumothorax means something is in the chest wall between the lining of the lungs and the lungs themselves: in this case, air. Usually it's caused by a hole in the lung. By placing a tube in the chest wall that keeps negative pressure on the lung and allows it to expand, you allow your patient to breathe and heal. Docs place the tubes, nurses monitor the tube and make sure the suction device (Pleur-Evac) is working. Very cool.

And then there were the psych issues. Wow.
And the pediatric patients.
And the people with heart attacks.
And the irrigation of a skin issue the size of a tomato.

Oh yeah, and there was that Stage II pressure ulcer I saw this morning on a patient when admitted.
I asked if we had checked this patient's back, and everyone shook their head. "Ok, I'll do it." So, sure enough, it stared at me like an angry eyeball, red, painful, and begging for healing. One of the nurses documented it, and then I repositioned our patient so there was no weight on that spot.
I felt like I actually did something there. I have no computer access, medication access, or ability to chart, but I *do* have the ability to care.

So that's what I did today.

When I stop caring, I stop being a nurse. And a human.

R.N.

2009-06-30T08:05:00.000-07:00

It's official! I looked up my name on the CA BRN, and it was there, appearing like a little neon light in the morning.

I passed the NCLEX!

So, now I am DEFINITELY going hiking in Glacier.

85 degrees and 70% humidity.

2009-06-29T14:57:00.000-07:00

Here's what the ranch looks like now. I was just caught on my bicycle in a lightning storm about two days ago in the same place I took this photo.

What did I do? I (fortunately) was on the stretch that had cell reception, and just 30 seconds before called for help from Will. I had looked up at the sky before I left- "oh, clouds, not bad - in fact, beautiful" but 30 minutes later on my ride, they were suddenly dark and had that this-looks-bad kinda edge to them. Black and thick, I decided, hmm, I might make it, but I'll call for a pickup just in case... That was the one smart decision I made.

When I saw the first bolt hit the field about a mile or so away from me, I have to tell you, it was pretty shocking (no pun intended).
There is nothing in the world like realizing you are the highest point in the field, sitting on a piece of aluminum.

I laid my bike down on the road and ran 100 feet away for the drainage ditch, where I squatted for the longest 10 minutes of my life. No, there was no water in it.
At least when it started hailing, the lightning stopped.
Will showed up with a truck like a knight on a white horse. I think I became a member of every religion for about 20 minutes that day.

So, humbled and more educated on Montana thunderstorms, not 10 minutes later it was sunny and 85 degrees again.

The saying here on the ranch is, "If you don't like our weather, wait 15 minutes."
Yeah, I guess so.

Ok, other fun pics from the trip so far.
Here's Idaho:

And here are my friends in Bozeman, during the pizza-and-champagne evening we had. It also included PBR, never fear:

So that's what I've been up to. We also went to an airshow in Helena, MT - where we watched the Air Force Thunderbirds perform, and got to check out some cool helicopters and planes. The focus on the military here in Montana isn't too surprising; it seems like a lot of folks are middle-America Apple Pie, and a lot of the kids go into the Reserves.

That's Montana for now. Off to Glacier soon.

Relaxation and a Roadtrip.

2009-06-25T10:06:00.000-07:00

That's a photo of my ultimate destination, where my honey is, taken in March of this year (it's a lot greener and warmer now).

Since the MEPN year has finished, I've been a busy little bee.
It's almost unbelievable that the year is done.

What's also unbelievable is the fact that I'm discovering as I type just how well pepper jack cheese cures a hangover. Delicious.

I drove from Reno, NV to Bozeman, MT yesterday. Why Reno? I used to live in Truckee, CA and the night before I hung out in Reno, we had a little BBQ with friends at their house on Donner Lake. I'm on vacation, make no mistake. Truckee was fun - low-key and chill, beautiful weather. I also embarked upon my first bike ride in a year. I refused to ride my bike in SF after a few friends were hit or run off the road by cars, so that's one thing I've looked forward to in Santa Monica; however in Truckee I used to ride all the time, specifically the 35 mile round-trip from Truckee to Tahoe City on the bike trail. Beautiful.

Some of our Truckee friends, disenchanted with the smaller size of the quiet mountain town, moved to Reno, where you can still buy a house with a yard without paying half a million dollars. Yes, you can pay that much, but by and large it's much easier to be a homeowner. Not that they are, but hey, the option is there.
In any case, Reno was a fun adventure. Nope, no gambling, but we met near the Truckee River kayak play spot, then went off to my FAVORITE bar, the Roxy Bistro which is located in the El Dorado. The Roxy has over 102 martinis on the menu, and I am all about good martinis. Especially when they're made with vanilla vodka, chocolate liquor and have a rim of white chocolate on them. Yum.
From there we ventured out looking for sushi, but, alas, Reno is the red-headed stepchild of Vegas, so that was difficult to find at 11pm on a Tuesday. Instead, we went to get an Awful-Awful at the Little Nugget, which was the most awesome place EVAR because it combined a burger joint with a bar, and there was Karaoke Tuesday to boot. Perfect for a band of lost river guides in danger of being too drunk who need food and have to be functional the next morning. The burger was huge. My friend Shelley and I split it, and then I proceeded to karaoke Don't Stop Believin'.
That was awesome.
I got up early Wednesday and had a beautiful (albeit slow) drive from Reno to Bozeman, fraught with greenery, wildflowers, poofy little clouds, and people driving 10 miles under the speed limit. Sheesh.
When I arrived in Bozeman, my friend Heather greets me with, "Want a glass of champagne?"
Um, yes.
Then she looks at me, "Oh, it's Veuve. Is that okay?"
Hell yes.
Thus began the evening of drinking champagne, eating pizza, drinking more wine, and me passing out around 1 wondering if I drank enough water (I didn't).
Hence I'm still horizontal, nomming on pepper jack cheese wondering if my friend (who apparently drank more than I did) is okay, and wondering if I should go get breakfast makings for her. Hmm.

I'm gonna start driving to the ranch where Will is this afternoon, which is a short trip, but I have errands to run for him (he's in the middle of nowhere), so I gotta get movin!

I love chillin' out!

NCLEX done!

2009-06-20T14:00:00.000-07:00

By the way, that's a photo of Mono Lake I took in December of 2008, which has nothing to do with my blog entry. It's just pretty.

So, I took the feared NCLEX-RN, which is the National Counsel Licensing Exam for Registered Nurses, and it's in the format of a computer-adaptive test.
What does this mean?
It means that the computer senses how well you are doing and gives you more difficult questions if you answer correctly. This feature would be all well and good, except that the minimum amount it takes to determine whether you can practice at entry-level competency is:
75 questions
The max? 265.
I think I would freak if I went to 265.
So you don't know when the computer determines your competency at 90% accuracy, you just know that it *could* shut off at 75, or the computer could decide that it doesn't know if you're competent at 75 and therefore you have to answer more questions. Yikes.
And it's not about getting questions right per se, it's about what level of question you get. Ugh.
Combine that with a bunch of over-achieving A students who like getting high scores, and you have a recipe for an anxiety disorder.
Around question 20, mine became insanely difficult, and the computer shut off at 75, which I was excited about at first, but also felt a little unnerved about.
"Did I pass? Or did I fail?"
I came to the point of not caring. It's done. I'll find out soon enough.

And bonus! Our transcripts aren't in yet, which means that we can't find out results with the Board of Registered Nursing in California. Yay. They won't release results until they know we've actually finished a nursing program.
Double bonus: California's not a "quick result" state anyways.

So, to avoid obsessive-compulsive searching for my name to pop up on the BRN site (it's our unofficial way of finding our license), I'm heading out, driving, to Montana where my honey is working as a producer for a show that's going to be aired next year.

The vacation has truly begun!

Oh Santa Monica, Yay!

2009-06-18T17:03:00.000-07:00

After my 3rd PPD test this year, and some issues with the water heater (like, it hasn't worked since Sunday), I'm finally settling in to my new place. Hopefully I'll have a hot shower by this evening. It's almost like travelling-

Pictures to be posted after my roadtrip to see my honey in Montana!

MEPN Reflections.

2009-06-04T18:13:00.000-07:00

Those are my hands. We're doing a small art installation at our graduation ceremony and they will be part of them.

Today I finished my final hours of clinical instruction, and it still hasn't hit home:
I'm done.

Monday there is a class, but I'm headed to a wedding, and I was okayed to go early in the quarter.
So really, I'm done.

This year has been very short, but jam-packed. We were talking about some heavy stuff at lunch, and I thought I'd post some of the stuff I've experienced this year:

Poop is just not a big deal anymore. Period. Cleaned up a lot of it this year, and there's probably more to come.
Was present with a patient who watched her husband slip away more and more neurologically as cancer took over his body. And cried with her.
Learned that yes, I *can* take care of four patients at once on a med-surge floor, but it's hard and I can't do it and be doing a good job.
Learned I have a ton more to learn.
Started an IV on someone who was scared of needles, first try.
Missed on a few people who were scared of needles, first try. Didn't go for a second.
Watched one of my favorite patients go through acute rejection of a transplanted liver.
Watched the team of doctors and nurses pull for her to get a second transplant, and I watched her go home happy and healthy from that second surgery. That was a miracle.
Sat in the ICU with a woman who was too sick to be transplanted, and had been begging us to "let her go home." I held her hand as she was dying, intubated in the ICU, and she turned her head toward me for a moment when she was supposedly "unconscious." And the next day I held her daughter's hand.
Watched the acute distress of a young man who had his last bit of hope dashed when we learned he was in acute rejection of his lungs. I don't know the last outcome, but it was not looking good.
Sat with that memory intensely when my friend, Anne, died following acute rejection of her lungs at age 33.
Helped take care of a 3 year old boy who was dying in the PICU.
Helped care for an 11 year old developmentally delayed girl on dialysis with spina bifida who was in pain and spoke only Spanish. And helped her family get in touch with translators.
Laughed with an old woman who was incontinent after being in the ED for 3 hours (I had just showed up). Her remark, "Well, if you guys had actually checked on me, you might have noticed earlier. What do you expect? I'm old!" She watched us running around like busy bees.
Listened to a 12 year old with Lupus who had been in the hospital for a month, and who told me that all she wanted to do was go home and hang out with her brother and her cat. And have a piece of pizza, for once.
Charted with a 4 month old in my arms who would cry unless he was held by one of the nurses. He'd turn blue if he cried: Tetralogy of Fallot, and he would sleep if I sang to him.
Cried from anger while taking care of a pre-teen girl who had been hit by a bullet while playing, and was decerebrate. She would make noises that seemed like frustration or pain, and the reality of that situation broke my heart. I was overwhelmed by the love of her family, and still feel sick over the way violence destroyed her life. When I saw her picture from her soccer team, taken a week earlier, I nearly vomited because I was so angry, and the change in her was that drastic. I will never, EVER forget her.
Had a frank, genuine conversation with someone who was diagnosed as a paranoid schizophrenic, who told me, "Wow, you calmed me down!"
Had a patient tell me he loved me, in a really sweet way, and I could not tell him that I loved him back, because how do you explain platonic love to someone who is in a locked inpatient psych ward? I mean, really, how?
Held the hand of a spouse who discovered her husband had been rejected for a transplant, and has a year to live....
and still haven't emailed them.
Held my tongue when a precepting nurse chided me for holding the hand of a woman in labor.
Auscultated - and played with - a girl who had two hearts. Yes, two. Heterotopic heart transplant if you want to look it up. Imagine the ECG.
Failed on numerous attempts of trying to do something good. Fortunately it didn't hurt anyone.
Made a little girl cry by not taking out her IV fast enough (don't prolong the bandaid removal).
Faced some of my own prejudices, especially in psych.
Let go of some fear of TB.
Saw a multitude of vaginal births, and a few crash C-sections. And a few scheduled C-sections.
Relied on friends. Including professors, who were really supportive in all the loss I experienced this quarter. Sheila and Lynn and Pam, thank you. Seriously- thank you all.

And I made some great friends.

Oh Yeah, I Got a JOB!

2009-05-30T07:13:00.000-07:00

It's been official for a few months, but I wanted to wait until the New Hire paperwork, etc was done until I posted about it.

I'm an ER nurse as of July this year. Woot! I feel super SUPER lucky to even have a job, and to have an ER job? Whoa. Awesome.

People have asked what I did. I started looking in October. My resume was done in December, and I had all of my recommendations together as well. I applied everywhere, even to places I didn't think I'd live (like LA), and ended up with a job at UCLA med center. Sweet. Nobody here in the SF Bay is hiring, and had I waited for a position here, I think I would have been unemployed. A lot of new grad programs have been canceled, which means there will be a shortage again, eventually.

I never thought I'd live in LA, but being next to the beach isn't such a bummer, let me tell you. Plus, it's only for a year or two, before I finish my MSN back at UCSF after this "step-out" year. Awesome.

So, I'll be moving here:

Coasting.

2009-05-29T16:27:00.000-07:00

After a year of insane studying, overzealous highlighting, crazy hours of driving and commuting, writing papers until all hours of the night, and severe lack of exercise and life:

I just turned in my last paper.

I am done. Now it's just the NCLEX, attending clinical, and actually exercising again.

San Francisco is actually pretty nice when I'm not running around like a headless chicken.

Keeping my Mouth Shut.

2009-05-02T08:33:00.000-07:00

So, last Friday, I had an amazing moment.
Most of the nurses on the floor in the hospital I'm in for L&B, who discover the woman who wants to give birth without intervention, who wants to do "Natural Child Birth" (OMG!), she's automatically labeled as: crazy, insane, masochistic, f'ed up.
And you know what I said?

Nothing.
I'm a nursing student. I kept my mouth shut.

What I want to say?
When I first wrote this, I was really really angry, and I typed out what I wanted to say. But...
I was taught if I can't say something nice, then don't say anything at all. So I didn't. I want natural child birth too. I think I said that, but in a very even tone, so as not to rock the boat. And I clearly remember the shock in the voices around me, "Really? Are you kidding?"

I respect the mama who wants to scream, moan, blow out her pain with her breath.
I respect the mom who looks at the doctor with "crazy eyes" and says, "I can't do this, help me, pull this kid out of me," and the doctor says, "You're almost there, you CAN do this, I know it, breathe, focus" and then winks at me with all the love in her heart.

And I DO NOT respect the "nurse" who interferes with that beautiful, human connection that the patient and I have.

My patient:
She reached out to me, grabbed my hand while pushing, one of her most intimate moments in life that she will remember forever, she holds me, and I whisper to her, "I'm here for you, I'm right here, and I'm not gonna let you go."
And the nurse, with her degree, and her NCLEX, and her knowledge- she subtly reaches over and peels that womans' hand from mine,
and places it on a grip bar attached to the bed and says, "You might feel more comfortable here."

And the baby boy is so beautiful, and mom and baby are so happy when he is finally with us in the room, "crazy" mom and her little boy and dad who is super supportive...
and the nurse takes me aside,
"So, that birth went well, but um, DONT EVER let a LABORING woman GRAB your hand like she did, she'll break it. Protect yourself. You did really well except for that one thing. You're not aware of your safety."
And all I could do was nod.
"Okay. Thanks."

Inside, what I wanted to say, "What. The. Fuck."

I had one of the most intimate moments I could ever have with a patient- she reached for me, gently, to support her, and that nurse, so afraid of intimacy, took it from both of us.

I think that moment really topped off a very disheartening day with this particular nurse, who seemed very disconnected from her patients even though she was young and fairly new. She liked hanging out with the monitors rather than being present with the patients, and I heard the charge nurse asking, "Please, can you help and be a team player? I really need you here." And this particular nurse, sighed, rolled her eyes, and stomped off like a toddler, not even introducing herself when she came in the room with the woman she labeled as crazy for just wanting to trust her body.

Even my Clinical Instructor: "wow, what a beautiful moment..." then I continued with my story... her comment, "how sad. How sad for that nurse that she didn't feel comfortable being present with her patient at a very vulnerable moment. What a sad, reserved, afraid human that nurse must be to be so unavailable at the moment her patient needed her more than anything..."

Exactly what I thought.
How sad.
And how sad that I kept my mouth shut.
I hope that young nurse changes specialties. L&B is not for her - sheesh, maybe not even nursing. But that's not my call.

And what a blessing to be present with my patient.
What a blessing.
How beautiful.
I support a woman's right to choose, and that includes the conditions surrounding her labor and birth. What a beautiful thing.
The MD asked if I wanted a job on the floor. If emergency weren't my thing and L&B were (ok, so it is, but emergency more so), I might consider it.
More to be discussed.

SANE/SAFE

2009-04-28T22:51:00.000-07:00

People ask what my ultimate goal is within nursing.
I have a few.

I want to be a Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner (SANE/SAFE) because we need them, and we need them to be helpful, caring, respectful, and good at what they do.
And they should work in emergency.
And in a perfect world, we would never need them.

Here's another story, besides ones from my friends that motivates me. Read at your own risk. I kid you not. If you can't stomach these things, don't read.
I cried for an hour after I read this story.

It is absolutely horrible but there are some good souls left in the world.

And having the tools to help someone in this situation is most certainly my motivation.
Let's stop this violence before it starts, people.

The day pig(s) flu...

2009-04-25T18:41:00.000-07:00

Well, it's happened.

Now we have a pig flu. We always wanted to see pigs fly, but with the swine flu, well, it's interesting to see what will happen.

I'm actually curious if the respiratory infection I've been fighting off is possibly due to the virus. The warnings are "if you've had contact with anyone from Mexico." Oh really? So, the entire state of California is at risk? Nice.

Seriously, I'm really interested to see where this goes, what the warnings end up being, and what our actions as students are.

MEPN is done in 6 weeks. I'm going to be an RN very soon, and that really really frightens and excites me at the same time.
I thought pigs would fly before this would end.
And I guess I'm right.

Let's Talk About Organ Donation, for a moment.

2009-04-11T11:50:00.000-07:00

I just lost a friend who was given extra years of her life due to someone's gift. She received lungs about a decade ago from a man who had the courage to donate, and recently, at the age of 33, went into an episode of acute rejection, aspergillis infection, and had also developed cancer in her abdomen.

I miss her terribly, and am in shell shock.
I can't even imagine what your family is feeling.

Please, if you haven't, register yourself as an organ donor. If nothing else, I got more years of knowing my friend. She was a beautiful soul, a real fighter, and will be missed by many.
Anne James Ferrari, you have touched the lives of so many. I am so lucky to have known you. Spread your wings my friend, and remember us here. We'll see each other again.

Please, donate life.

And for those of you still here, live every day. Carpe goddam diem.

Here's a photo of her and her beautiful sister (who is also becoming a nurse. I love you, Beth):

The Cycle Continues

2009-04-10T19:19:00.000-07:00

I'm backdating this blog entry, mostly because I like having Anne's sunshine smile at the top of my blog.

Friday, the 10th, I spent my first rotation in Labor and Delivery. Here's a summary of the experience:

My brand-new clinical instructor is moving very quickly towards us, somewhat breathless.
"Okay, Nicole, you and (male MEPN) are in the delivery rooms, and everyone else is in Post-Partum. Go change into these scrubs. And the women in those two rooms are pushing. Hurry!"

My cohort and I look at each other, high-five, and nod. Neither of us even had time to register nervousness- I mean, I had never seen a vaginal birth, only a C-section, and we have had about three lectures on pregnancy. New scrubs on, we stepped out, ready for the day.
For about ten minutes the nurses we were working with hemmed and hawed about the number of students allowed in one room, and I told him to go ahead- as a male, I know it's more difficult for him to be accepted into a delivery room. Not today. He merged right in to the room, needed and accepted. He had only been in there two minutes, when I hear a call for, "Hey can I get another person in here?!"
So I stepped in.
"Um, I'm a student, what can I do?"

A nurse looks at me, "Grab that towel and go hold her leg so I can hand tools to the doc."

The patient is in a traditional hospital-birth supine position, her husband is at her side. They are super cool, and very calm, all things considered.
"Hi, nice to meet you. I'm Nicole." Contraction.... "Okay, breathe deep with me, ready?"
And that was it. Off and running. It's 7:15 am, and I am helping hold this woman's legs open for a difficult birth, trying to remember what I can about fetal heart rate decelerations, next to her husband (who is also totally rad), watching the doctor work, realizing that this baby is in a little bit of trouble. And I'm watching the baby's head crown.

Holy Shit.

And I thought, silly me, that the head would be way smaller than it was.
The OB was very calm, and grabs the vacuum to help get this baby out. I see the FHR (fetal heart rate) is about 70.
Not so good.
Doc, very slowly but firmly. "Get Peds in here. Now."

A team of 3 superhero nurses emerge from the ICN, ready. They're setting up oxygen support, and the warmer.
The woman pushes again.
"Call Dr. XXXX. Get him in here." I realize that she's calling for the attending.
"Okay, now push. Hard. We need him out of there."
Attending arrives, steps back close to the ICN nurses.
Our laboring mama listens. Another nurse is pouring mineral oil and olive oil on the crown of the baby and on mama's perineum.
And all of a sudden, I realize just how huge that head is, because it's coming. Fast.
And just like that, there's another person in the room.
"Floppy baby."
Not a good thing.
He's blue and floppy, and the cord was wrapped around his neck, twice. Not 2 seconds into the world, this little guy is under a warmer, being rubbed down, suctioned, and bagged with oxygen.
The trio of superheros is working, hard.

It's almost too much to absorb. I look at mama, I look over at baby, and then I look down at mama and she asks me (and the doc), "Did I tear?"
It took every ounce of my consciousness not to look incredibly shocked.
Um, yes.
The OB: "It's not that bad."

Apparently, it's not that bad, but I have never seen a vaginal birth and I could not believe what a "not-that-bad" tear looked like. And the amount of blood that was associated with this process I was NOT prepared for.

I keep myself together, "Yeah, not that bad. How are you doing?"
And then I look at dad. "How are *you* doing?"

We start bantering, like we had known each other for a while. I glance over at the busy trio and the once-blue baby. He looks pink, to my relief. It's been almost 10 minutes.
Then we hear it... He cries!
I sighed, audibly. Everyone in the room noticeably relaxes.

They bring the little guy over to mom and dad, and let them say hi, but he was on his way to the ICN to be watched for a little bit. Both mom and dad are medically savvy, and they nod. Mom looks tired. Baby looks pink, warm and dry. He looks a little mad after being suctioned, and he's probably a little dazed.
"How long were you in labor?"
She looks at me. "31 hours."
My male MEPN companion and I look at each other and our jaws drop.
"Um, can I get you some juice?"
She laughs, and nods. "Yeah, that'd be great."
The OB is busily sewing up the tear. This mama had an epidural, which she relates is what helped her make it through. It's not even 8am yet.

And that was the beginning of the day. Literally, 2 hours later, I'm watching a C-section, then an hour after that, I'm holding the legs of another woman who didn't get an epidural because her baby was on the fasttrack into life. First baby, and she only pushed about 5 times. She tore, too. And let me repeat, NO epidural. Her baby came out with a loud cry, pink, and feisty. Good sign. The doc was trying to numb her up to sew her back together. Again, not a bad tear, but on my first day, it was pretty shocking.

At that point, I thought to myself, "Is there a third option?"
If I invent anything, it's gonna be a baby transporter beam, a la Startrek.
And I had a hell of a lot more respect for all the women I know who have gone through this process.

I then spoke to my Godsister, who is a NICU (ICN) nurse, and she relayed to me that usually women with epidurals tend to tear more often because they can't feel pain, so they don't allow themselves to stretch enough. Makes sense, naturally, when it gets too painful, you stop, take a breath, relax, let yourself stretch, and then begin pushing again. Huh. I am going to ask my prof about this (not that I don't trust my godsister, I just want to ask my professor).

L&D started with a rush of emotion.

So on the same day that I was there for 3 new people coming into the world, someone I really loved transitioned to another one.

Which is a wild head trip for me.

In the past few weeks I've lost a lot of people I've known. See my prior post about one group, but I also lost Shane McConkey, who was a trick skier filming in Italy, and fell. One of his skis didn't pop off, which screwed up his balance and from what I understand, his parachute was tangled in his ski. So he fell. 400 feet. He was only 39, and he was the most bitchin' landlord I ever had- he used to come over and drink beers with us, and his wife Sherry used to come visit as well. I remember how excited she was when she told us she was pregnant. Shane was awesome- he knew I was trying to improve my skiing and offered to ski with me, which floored me. Shane was a legend- he was Squaw's guy, and he was a friend to so many, and so down to earth yet nutty and fun. Total prankster, and totally loveable. He leaves behind his wife, Sherry, and Ayla, his daughter.

Too much.

It's a cycle. I haven't confronted death in a long time, and I've never seen birth like what I saw on Friday, so I guess it's time for reflection.

Side Note:

2009-04-03T16:22:00.001-07:00

This is just wrong. I'm not sure if I should be frightened or in awe:

see more pwn and owned pictures

Spring has Sprung.

2009-04-03T15:46:00.000-07:00

So, I had an epic adventure in Montana.

Actually, it's a long story, but suffice to say, it took a lot of creativity to get home.
I'm really glad I'm in Schedule A. We had a two week Spring Break, which was much needed- as much as psych and pediatrics was a lighter schedule than med-surg, the energy involved in caring for the patients was very intense, and I'm glad to be in the community health quarter with Labor and Delivery (babies! Yes!).
I'm placed in a TB clinic which is frightening but important work, and I'm curious to see how things unfold. Our issues in nursing class is also WAY cooler than I thought it would ever be- I am really diggin' the course already. Our dean is articulate and real, and for that I am very grateful- she rocks.

And I got a job! I started looking early. REALLY early- went to career fairs in October, checked out stuff in December, and I applied by happenstance to UCLA med center. Within 4 hours of submitting my application, I had an email that invited me to interview. I called immediately, and got an ICU interview. Then I called back and begged for an ED interview... those were not public, they were reserved for people with Emergency experience.
Awesome. I thought I bombed it. The unit director was very cool, but told me that there was only one position. I cried. I felt like, "wow, I'm great, but I'm going back for my MSN in a year or two, and that's working against me."
She hired two of us.
So, not only do I have a job, but I have THE job that I've wanted! Super super happy dance wiggle excited. So, I live in LA for a few years. Right on, I've always wanted to check out a beach town, and UCLA med center is a Magnet Hospital- they are amazing- and I love the vibe. The nurses, techs, and docs are color-coded by scrubs, so you can tell who's who when you ask for help. They're all about being polite, and I find that VERY important.
Super cool.

On the down side, a large group of people that my family knows died in plane crash in Butte, MT, and I'm just reeling. It makes starting the quarter a bit odd. Three couples and their kids, 7 children in all. 14 people. Senseless. And, because one of the members of the family owns abortion clinics, the idiot anti-choice people are protesting the memorial service tomorrow. I'm sorry, but there's a time and a place, and that's NOT it. Hmm, let's advocate saving unborn inviable fetuses, but celebrate your horrible heartbreaking loss of active children- WTF?!
I'm disgusted.

And a good friend of mine who had a lung transplant 13 years ago is in the ICU with an aspergillis infection. I am very very worried about her, and I know what that means. She's also fighting some other stuff off, and it's been a struggle for her. I've been waiting for facebook updates to keep me informed.

Doesn't make the first week of the last quarter easy.
There's a lot to think about.

*Deep breath*

I went to bikram yoga today for the first time in about a year. It was absolutely heavenly to be in shivasana and be mindful of my body, to focus on moving and on breathing instead of on running around like a madwoman.

Two friends of mine are beginning MEPN this year as well, both whitewater guides. I'm super excited for both of them, and it makes me happy to know that there are more female guides heading into the world of nursing. :)
Yeah!

Okay, that's the report. Stay tuned..

Psych, and changes

2009-03-15T21:25:00.000-07:00

It's been a long time since writing.
The psych rotation has been brutal. Aside from driving to Palo Alto 3-4 times per week, it's just taxing.
We're in an acute inpatient locked ward from 7:30-12, with discussion afterwards from 12-1.
I carry the key for the three students who are on the floor.
It's tough. I almost just wrote "it's insane" but I felt if I wrote that, it's not for the reasons a reader might think they are. It's the entire situation. We were lucky enough to be plopped right into the center of Veteran's care at the VA, so not only were we dealing with psych, we were dealing with psych in a military model.
For one, the psychiatrists and the psychologists were absolutely amazing - incredibly compassionate and intelligent.
The patients were really interesting. I saw people with PTSD, schizophrenia, borderline, schizoaffective, major depressive, generalized anxiety, conversion disorder, etc. Everything under the sun. Everything. There was a patient who had a cure for everything you could imagine, who was incredibly intelligent. There were patients with criminal histories, who were amazingly sweet to us but when we read about what they had done, our hearts stopped and we wondered how they could have performed the atrocities they did.
Intense doesn't even begin to cover it.
Aside from the stress of driving so much, the psychological stress of being in this environment was definitely tangible.
Bearing witness- we were constantly bearing witness to other people's pain, whether that was wondering if the devil was putting voices in their heads, wondering if their families loved them, wondering why they had been hurt.
I met one patient who I just connected with right off the bat. He hadn't eaten in a while, and was there voluntarily, depressed. He told me I could never understand.
I just listened, and tried to help as much as possible by just being present and just being kind. Three days later, he started eating.
Two weeks later, he told me he loved me, and it caught me totally off guard. I had no idea what to say back- how do you explain that you have care and compassion for someone without saying that you love them "in that way"?
How do you do that?
I said, "Thank you. I wish the best for you."
And I felt like an asshole. But I was still present for that patient in his moment, and I felt like that was the best I could do at that time.
There is so much I'm not writing.
That's what strikes me about MEPN. I am pretty conscious of HIPAA, so I try not to write too much about patients or I change things about patients I interact with- or I just don't write about it.
There is so much you will see that you won't write about.
So much.
Psych has been an amazing experience.

Mixed insanity. Controlled.

2009-02-08T09:51:00.001-08:00

I don't know what bothers me more: the fact that I saw/touched/witnessed a dead baby in the NICU or the fact that it doesn't bug me as much as I thought it would. I felt awful, but also like I was learning, looking at and touching this poor little guy. He was so small, infinitely smaller- he didn't even seem real. He had been born 10 weeks early, which had given him a lot of disadvantages.
The nurse told me the parents didn't want to see him. I understood. That's not the memory you want. She was in process of taking a handprint and footprint and photos to put into a memory box for them.
That did get to me. I choked up at that point.
He died of NEC which affects a lot of premies, unfortunately. His head felt really boggy, and his abdomen was distended. The nurse who had been working with him was sad, but she also knew she and the team had done everything she could. She felt like it was a difficult battle for 12 hours. Once blood pressure drops and your blood stops perfusing your vital organs, it also stops perfusing things like your GI tract, and that means you have fewer defenses/less circulation going to the places that need it. Even with the heavy antibiotics he had been on, it just wasn't working. Sometimes, it just doesn't. Sometimes no matter what you do, it's just that patient's time.
Sigh.
The rest of my day in the NICU was much less emotional. I got to hold some of the cutest, tiniest little people I've ever seen, including one who had Down's syndrome and was the most adorable little guy. He loved following people with his eyes. I wanted to love him all morning, but he had other plans: sleep.

I also saw babies who had successful heart surgeries, who were doing well. It wasn't all gloom and doom- and the level of care I witnessed in the NICU was AMAZING. The nurses were extremely aware of hygiene and of taking care of the entire family. I was highly impressed by their abilities to work with parents, and their deft abilities to calm the newborns. The doctors that came in where communicative and kind. One apologized for waking up a sleeping little girl, and promised, "I'll get her back to sleep"... and he did, gently rocking her. The NICU was a medical place with heart. I can understand why people work there, and I'm glad I was able to experience it.

This quarter is flying by. In fact, the year is flying by. We're almost 3/4 through the MEPN year and it's hard to believe. I feel as though I learn so much every day, and it's difficult to keep up blogging about it, partially because my free time is spent sleeping or writing papers, partially because it's tough to find the words to write.

If you become a MEPN, you'll understand.
Wow it's almost over. I keep shaking my head. But now the next problem comes around, and that's the lack of jobs for new nurses...

A New Year

2009-01-14T20:31:00.000-08:00

It's been a while since I've posted anything, partially because MEPN makes you want to take all your extra time to yourself. There's hardly anything left to share with others some days because you are so exhausted, but that made vacation super fun.

We had six weeks off, which started at the end of November and ran through the new year. What did I do? Everything. Nothing. I slept about 12 hours/night for a week. I ate turkey. I hung out with my boyfriend and my family. I danced all night. I took ACLS and PALS. We went skiing, backpacking, eating, eating some more, and skiing again. Then, we danced all night on New Years' Eve and then went skiing.

It was spectacular.

School started again, but for whatever reason, it's not as daunting. We're past the halfway point, our class has formed friendships, and we sorta know what's up.
I'm even taking an elective this quarter: Wilderness Medicine, which I love.
I became a student editor for papers (for researchers in the MS/PhD programs), using a paper which earned me a less than spectacular class grade, which is a bit frustrating - obviously it was good enough to get me an editing job using APA format, etc, but the professors took off points for random stuff last quarter, which was never really itemized. Whatever. My GPA is still high, and more importantly, I've learned the things I need to learn. And I can do them well. That's way more useful. Remember, it's about concept *and* application.

This quarter is about Pediatrics for us, with some Psych peppered in at the end. I'm loving working with children, to the point where I'm thinking about working in the PICU at Lucille Packard. Of course, eventually I'd try to move to the ED at Stanford (which has a wilderness medicine section to it), but I want to try something different for a while which could help me in my learning process and my endeavors that still encompasses what I want to do.

The job market is abysmal for us new grads. Kaiser revoked their contracts with some of their new hires, and that's pretty startling for us who have to take a year (or more) off.
Sigh.
In any case, the immediate happens to be enchanting me. I'm loving my pediatrics rotation. What a wonderful thing, to relate to children, to play games and to help them feel better.
I love it.

Now, the other interesting thing for me is watching the new applicants be nervous for their interviews. I've been following on allnurses.com, and the threads remind me of how scared I was. Many of the MEPNs wish they could be there for the incoming folks, but we weren't scheduled for lunches this year. If you're interviewing, relax, get some sleep, and know that we're all wishing you luck.
:)

Love of Doing Nothing.

2008-11-23T11:18:00.000-08:00

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.

2008-11-13T21:30:00.000-08:00

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.

2008-11-09T21:41:00.000-08:00

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

2008-11-04T06:12:00.000-08:00

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.

2008-10-27T20:39:00.001-07:00

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.

2008-10-09T20:53:00.000-07:00

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.

2008-09-30T20:27:00.000-07:00

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.

2008-09-18T20:53:00.000-07:00

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.

2008-09-12T20:46:00.001-07:00

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.

2008-09-11T21:19:00.000-07:00

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.

2008-09-04T14:55:00.001-07:00

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

2008-08-27T07:56:00.001-07:00

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.

2008-08-19T22:13:00.001-07:00

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.

2008-08-18T09:28:00.000-07:00

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

2008-08-17T13:06:00.000-07:00

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.

2008-08-01T22:05:00.000-07:00

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

2008-07-29T20:51:00.000-07:00

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

2008-07-23T16:51:00.000-07:00

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.

2008-07-20T08:13:00.000-07:00

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.

2008-07-11T20:01:00.000-07:00

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.

2008-07-10T05:44:00.000-07:00

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

2008-06-24T22:02:00.000-07:00

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

2008-06-21T21:02:00.000-07:00

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.

Books. And 3 weekends left.

2008-06-06T11:14:00.001-07:00

This weekend is one of the last three I'll have free for six months. My boyfriend and I are heading to one of my favorite rivers, the Kings, to chill out, work a little, and hike/swim a lot. I'm growing more and more excited to start this program, and feeling some trepidation towards what changes lie ahead.

Sigh.

I just got my books. All $440 worth of them (!). Some other folks have found the same books on Amazon.com, but when I looked, it seemed like the editions were not correct, so I went with the university bookstore. It's been a long time since I've written a paper in APA format- my original BA is in Literature and Women's Studies, so I wrote in MLA. Little things, but still...

We have a gmail group of incoming MEPNs, all 20 of whom are talking about what to expect, what the class schedule might be like, what the work load might be like. Anticipation seems to be thick among us.
And we're wondering if our clinical placements might be geographical in nature this year due to gas being $4.25+/gallon instead of $2.50/gallon.

So, scrubs (check), books (check). Questions will be answered on orientation day.
We apparently have also been given MEPN "buddies" who are available to answer questions for incoming students. They're in the middle of preparing for graduation, so this week is tough as far as getting in touch, but I think the concept is intelligent.
It seems we'll get some more info as to what to expect for the summer, and the year. I'm also curious as to what the job prospects are for RNs and NPs, post-graduation.

The Countdown begins...

2008-05-17T09:51:00.000-07:00

Finally moved in, and it's 90 degrees in SF. Wow.
So, things have been moving along. We've been getting letters that include stuff we have to do pretty much weekly. We got logins and dates and deadlines and such.

Let me give some more advice: DO YOUR HEALTH FORM ASAP.
Because I'm stuck.
I had a titer come back negative, which means I didn't have antibodies from one of my immunizations. It's varicella; apparently I never had the chickenpox. Ha.
That requires one injection now, one 4 weeks later. If you don't have your health form in, your account is placed on hold. Kind of a problem. So, future MEPNs, do it!

Every time I feel like I have a break before school, I find that there's a bunch more stuff to do- I just ordered scrubs in the uniform standard of UCSF (not white, thank goodness!), fixed my danskos- which are the most comfortable shoes in the universe. Filled out the MPN for financial aid. Reality set in fast when I did that.
We started a MEPN group on google, so about 15 of the incoming class are talking to each other about financial aid and such. This group has been considerably helpful.

A few other thoughts:
Get a good stethoscope. I have a Littmann. They are expensive, but think about the fact that your steth can last for decades. In that light, $150 is not so much money- and it makes a huge difference. The little cheapy scopes make it difficult to hear heart sounds in a busy environment, and my Littmann has always made getting a difficult BP or heart sound much much easier.
http://www.allheart.com/lit.html
Trust me, it's worth it.

Also, SF Paramedic Association has CPR classes available. My personal opinion is that a Healthcare Provider should have at least Healthcare Provider CPR, not just Adult/Infant/Child.
If you already have you HCP-BLS, you can renew it in 2 hours through SFPA, which was stellar.
BRING YOUR AHA CARD. If you don't, you will be asked to leave and have to pay $15 to reschedule. I watched in horror as this happened to two RNs who had signed up for the class I was in.
http://www.sfparamedics.org/

Now we have about a month before we're fitted for TB masks. Orientation is on June 20th. Classes begin June 23rd.
The only injustice I can see so far is that finals are Sept 2-5, right after Labor Day weekend. This means 1) No Labor Day vacation for us, and 2) probably No Burning Man for me this year.

Some cool realizations:
1) I'm not going to work a full river season this year. I'm already scheduled for 5 Tuolumne trips in the next two weeks, and you know what, I'm actually kind of excited to have a little time off from the river for the first time in 10 years. I get to go to concerts this summer... maybe.
2) I'm living in San Francisco, and Pride Weekend here is going to be a blast. Straight friends, gay friends, bi friends, trans friends are all around, and everyone wants to go. My boyfriend and I are going. It's the first time I get to go while actually *living* in the City. Even if I have homework, I'm going to the parade. Many friends of mine are marching in the parade, and I'm rather open about who I am - I've had girlfriends in the past, and a boyfriend now. I get to march if I want!
3) We have a kickass view of the Golden Gate Bridge, which means we don't have to go anywhere during Fleet Week. We can just sit on our balcony...

Looks like it's going to be a busy month.

Preparations..,

2008-04-08T10:53:00.000-07:00

So, now that we have a place in SF (house hunting was oh-so-fun), there is so much that I have to do, according to UCSF.

Recommendations:
1) If you don't have Healthcare Provider CPR already, look around for a class. You're going to need it for the rest of your career, so you might as well do it now.

2) If you work in healthcare and have already had the surface antibody test for your Hep B or for Rubella, save it (I did). It'll save you another lab test.

3) Do your first PPD early. You have to do two of them, so I'm off to do mine this week. Fortunately, I work in a clinic that does pre-natal care, so they do routine PPDs and I can just sneak in and sneak out.

4) Craigslist for apartments was helpful, but so were friends. The "Places for Students" website that UCSF has is pretty good, but limited. If you have to relocate, I suggest looking early. The market for us was pretty easy- even though people are saying it's tough for renters, I think that's an idea perpetuated by forms of media. My experience was that apartments stayed on the market for 2 months, and I watched the rents drop a little before I started looking. Then again, I started looking in March in order to get a good place...

Oh yeah, and we found one. We have a spot in Cole Valley that's about a 3/4 mile walk to UCSF for me. Now I just keep my fingers crossed that my clinical placement will be there too!
Sigh.

March '08: It's On.

2008-03-09T09:05:00.000-07:00

After spending the last 6 months wondering, applying, grasping at information from various blogs and friends and attempting to read the minds of the admissions committee, I got the letter I wanted "We are pleased to inform you..."

(Happy Dance ensues)

The multitude of blogs about UCSF's MEPN program inspired me to write my own, after all, I do have a degree in Literature. So, it's March, and before I forget things, I thought I might write down the experiences I had in getting to hold the little acceptance letter in my hand.

First of all, I have to admit, I applied (well, re-applied) to this program at the last minute. I had applied two years ago for the FNP specialty, and after working in a clinic 8-5 (which really means 8-6:30, and those of you who work at clinics understand this concept), I decided that FNP was NOT what I wanted: hence, the initial rejection was a blessing in disguise. I spent the past two years applying for UC Davis' PA-C program, but really wanted to do an NP, just not work in a clinic.
I was bemoaning this fact one day, and my friend Jen, an ER nurse, tells me how she's going to apply for the ACNP specialty at UCSF. "What?? That's a specialty??" Light bulbs go off, and I realize that my ultimate goal of working in an ER or ICU as a healthcare practitioner can be accomplished.
I head back to my clinic with my new-found knowledge. The FNPs I work with absolutely glow when I tell them of my plan, "Yes, that's PERFECT for you. You have to become an ACNP, you'd love it!"
I learn more about the delineation between nursing philosophy and PA philosophy, and decide, yep, it's for me.
Except at that point I think it was September 10th. The UCSF app is due Oct 1, including GRE scores. And my original scores have expired.
Somehow, I got all of the application material in, and power-studied for the GRE.*

The waiting began. November passes by, December rolls around. On my 30th birthday, Dec 22nd, a Saturday, my friends and I are hanging out at my house in Sac, drinking champagne and having a generally good time.
My mom calls. "We are pleased to inform you that you have been offered an interview..."
Cheering ensues. Best. Birthday. Present. Ever.

Interview day occurs. The applicants who receive interviews are divided into two groups: one group interviewed Jan 18th, one group Jan 25th, and as far as I can tell, it has nothing to do with how *likely* you are to be accepted (I interviewed in the second group). The day is long, but really fun. Go to the meet-and-greet the night before if you can; it helps you to recognize other students and makes the day a bit more comfortable.
I ran into a good friend from my post-bac program at Mills that day, which was a wonderful surprise, and made me feel that much better.
You will have two interviews. Some had them the same day. Some had them different days at varying locations. Don't stress about this fact. The interviews are in the morning, between 9a-noon, so you get it done. Drink your coffee. Relax. You will do an amazing breathing exercise. The faculty are there to assess your academic preparedness, and to see if you have a personality. It was really, really fun. Remember, you are there to interview them as much as they are interviewing you.

My second interview was off-site, later in the week. I took the entire day off, and before the interview I got a croissant at Tartine, the best french bakery in SF. It's on 17th and Guerrero. I don't eat croissants, but I do from here. Yum.

After the interview comes the two months of distracting yourself. Don't obsess over what you might have said. I felt like I said a few things I shouldn't have, wondered if I could have asked more questions, but overall, I was polite and real.
Things that are good to know:
1) Why nursing? If you can't answer this question, then I have to wonder why you're applying.
2) Know yourself and your personality. Answer honestly.
3) I found it helpful to know the nursing philosophy (it's why I'm applying to this rather than going through medical school). What makes a good nurse, not just a nurse, but a *good* nurse.

And, yes, the acceptance letters are THIN.

Now comes the housing hunt. Although school starts in late June, I want to be able to move and settle in before school overwhelms me. Plus, if the move is done, I can still be a river guide during the high water. And I can take time to explore San Francisco.

Hope that's helpful. The housing is really overwhelming. I've looked at a lot of places and they are expensive. Brace yourselves for the price. My boyfriend and I are looking together, so that makes things a little easier. We're also planning for the influx of friends who will be hanging out at our house...

And so it begins.

*Note for those afraid of the GRE: it's not that bad. I used the Kaplan book and CD-rom, an entire $40 spent, and I scored very well.