October, overwhelming.

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.

Teaching.

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.

No, really

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.

Spring Cleaning

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.

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.

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?"

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.

Bunnies have more fun.

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.

Adventures in Big Emergencies.

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...

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.

R.N.

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.

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.

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!

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!

MEPN Reflections.

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.

Keeping my Mouth Shut.

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.

The Cycle Continues

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.

Love of Doing Nothing.

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

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

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

Ahhh, vacation.

For a Patient.

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

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

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

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

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

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

-Emily Dickinson


Morpheus

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

Alexander Sergeyevich Pushkin


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

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

Maybe I'll see her tomorrow. Maybe not.

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

Namaste.

Feeling Alive and Radiant.

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

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

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

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

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

I feel in love with life again.

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

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

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

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


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


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


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


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

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

And opening to life.
Opening.

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

Letting the light shine on!