Firsts, Escapes, and Anniversaries.

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

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

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

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

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

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

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

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

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

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

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

Holding Each Other Up.

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

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

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

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

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

Today. In pictures.

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


What my 5pm-6pm hour was like:

Except it really looked more like this:


How I felt after a 12 hour shift:


How everyone else felt all day:



What is fixing my sanity now:

And:



What I'm about to watch:


And how I feel altogether at this moment:



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

Ch-ch-ch-changes.

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

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

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

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

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

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

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

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

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

That's all.

Ahh, sleep and relaxation.

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

Pics of the Duck in day and night:




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

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



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

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

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

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

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

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

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

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

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

Sunny Days

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

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

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

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

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

Blogging, Exhaustion, Anonymity, and the Four Agreements.

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

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

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

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

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

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

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

1) Be IMPECCABLE with your word.

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

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

2) Don't take anything personally.

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

3) Don't make assumptions.

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

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

4) Always do your best.

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

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

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

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

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

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