Anniversaries and such.

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.

Unicorns and Rainbows and such.

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!

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.

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!

Magnesium and Bananas, Oh My.

It's the little victories that rock my world.

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

Okay, now to the good stuff:

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

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

Those little victories keep me going.

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

I took a very short lunch.

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

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

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

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

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

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