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.

"Because you don't suck."

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.

Been a while.

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.

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.

Intensity, and a Labor of Love

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.

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.

All Thumbs

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!

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.

SANE/SAFE

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.

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!

Turning Seasons.

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

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

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

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

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

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

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

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

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