30 Before 30: #17 Dye my hair

I decided in September that my 27th year would be my "year of blonde". (Sidenote - I know it's not grammatically correct to put periods outside quotations but I do it anyway because it doesn't look right otherwise). (SEE! We put the period after ellipses!! Why not quotations!?). Anyway, back to my year of blonde...

I bumped into an old friend who is a hair stylist now and set up an appointment with her in September. I went in totally convinced I'd walk in a brunette and out a blonde. Apparently it doesn't work quite like that because it has taken three months to go from this...

To THIS!!!...

I still am going to go lighter, but so far this is where we are at. I had my first OH YEAH, I'M BLONDE moment today when I was buying hair clips at Target and realized I needed the lighter ones instead of the dark ones now. Weird!

the guy who says goodbye to you is out of his mind

50% Nurse

Sometimes I stalk the UCSF MEPN 2012 message board on AllNurses.com just to keep tabs on what the incoming class is chattering about and where they are in the application process. Surprisingly (or not?), I didn't get into any of the posts during my own application/admission cycle, but I am drawn to them now. This week last year, I got the letter in the mail inviting me to interview at UCSF in January. I scotch taped it to my wall next to the mirror in my room - visible, but sidelined. A long shot that I spent a lot of miles on Iron Horse Trail plead-praying for.

I had my last day in Marin, last day on L&D, turned my last final in on Sunday morning, and now I'm 50% RN.

We are all feeling this way - I've seen a lot of "halfway there"-type facebook status updates. I think they're all filled with some mix of feeling relieved to be done with this quarter, disbelief we've already made it halfway through, and panic that we only have halfway to go before being BRN eligible to sit for NCLEX. Whoa. (Said like Joey).

On my last day on 15 Long, my mama delivered at 0646... exactly 14 minutes before my shift started (just my luck!). I walked into Labor Room 5 right as the baby was taking his first cries. I missed his coming  into the world, but thanks to the awesome RN I was shadowing for the day, I got to take the lead on so many other firsts for him in the initial postpartum period. Mama's family had to go to work, so she was left alone in the room within about an hour of delivering a calm and very alert baby boy. She hadn't really been able to bond with him yet except for some initial skin to skin contact when he was born, so I wrapped him up like a baby burrito and got to take him to mama to hold for the first time. I introduced him to her and she cradled him in total disbelief. She kept saying "Oh my god!" as she looked at him, processing her motherhood and her power.

I helped her breastfeed (he latched right away - clearly helped by the fact mama had elected not to have an epidural), and gave baby his first bath, shots, and drops. And hell if I didn't sit on the side of the bathtub for an hour with mama across from me on the toilet as she struggled with her first post-delivery pee.

That evening for post-conference, our group grabbed a drink down the street to wrap the quarter up. My Clinical Instructor shared that the best part of her experience with Fall MEPNs is that we are still such baby nurses at the beginning of the quarter, but by the end of the rotation she has seen each of us look, act, and feel like nurses. I got teary when she said that, because indeed I have spent the last six months feeling mostly like an imposter when I throw on my scrubs and stethoscope. But facilitating mom-newborn bonding one minute, educating about breastfeeding another, feeling a boggy uterus firm up with fundal massage the next minute, and then sitting on the edge of a tub for an hour for the sole purpose of moral support and reassurance... made me feel like a nurse.

And then I went back to being in the way, slowing providers down, and taking five minutes to get vitals. Sounds just like a 50% nurse... with a lot more to learn.

Ready for a Harbaugh-handshake, Clint?

It's College GameDay! It has been an awesome season at Stanford Stadium so far - tailgating in Eucalyptus Grove... playing corn toss thanks to my dad's superhuman carpentry skills... and most importantly of course, watching the Cardinal go 7-0!

And while we have been LUCKy (get it? ahh I'm so clever...) to have won by at least 27 points and as many as 54 points in every game so far, I have to admit that I'm a teensy nervous for today. Because TODAY is... DAH DAH DAH....

Ohhhh lordy. Let's look at the last five, shall we?
2010: Stanford 37 - USC 35 (Not exactly decisive but... I'll take it!)
2009: Stanford 55 - USC 21 (ahhh that's more like it :))
2008: Stanford 23 - USC 45 (oh NOOOOO... I blame this on USC revenge for 2007)
2007: Stanford 24 - USC 23 (Unranked Stanford upsets #1 USC!!)
2006: Well. This is my blog. So I get to say who cares about 2006 anyway? To hell with 2006!

Now, I love Stanford Football. I want to go to sleep tonight at 8-0. It's alllllll about the game. And the win over a team I have hated since the 1996 Rose Bowl against Northwestern. But the Stanford vs USC match up goes deeper than all of that. Every year, this day is not just about beating USC. It's about a whole year's worth of bragging rights over USC's biggest fan (and one of my oldest and best friends) Clint Bradford. For Clint and I, the razzing, the glory, and the passion behind the rivalry is ongoing no matter what day of the year it is. Let me be clear (ha, clever me again!), the clashing of horns between us about USC can be funny and friendly... but it is most certainly *serious*. So today I am practicing my BEST Jim Harbaughesque handshake in preparation for my victory celebration over Clint (err... I mean Stanford's victory over USC) when the buzzer sounds tonight. Are you ready for me, Mr. Bradford?

It's the wheel of the world turning around

This quarter I have a Childbearing Families rotation on 15 Long at UCSF every Friday. I'm assigned to a different part of the unit each week; postpartum, high-risk antepartum, lactation, well-baby nursery, and the BEST... labor and delivery. Last Friday during the 7am nursing hand-off, my nurse and I got pulled away because the patient we were assigned to was having continued decelerations (where the baby's heart rate drops significantly and takes a few minutes to go back up to baseline). Some decels are normal (with contractions, for example) and decels with variability (where the baby basically bounces itself back to normal) are typically ok. But this little stinker was having sustained lowered heart rates and was making everyone nervous for most of the night before and into that morning. We tried a number of nursing interventions on mama, but ultimately she had to sign the consent forms for a C-Section and by 10:30am we were suiting up for the OR.

Five layers of tissue (skin, fat, fascia, muscle, uterus) and an hour or so later, baby boy got pulled out of mama and we heard him use his little lungs after the peds team went to work a bit. My thoughts on the whole C-Section process? Other than fetal demise or injury, I can't think of a worse pregnancy outcome than a C-Section. Are they necessary? Yes. As much as we do them here in the States? Come on. It is incredibly invasive and traumatic and sterile. It is SO far from what our bodies intend for the childbirth experience. But I digress. Either way, it was pretty CRAZY to see a huge melon-sized uterus resting on top of mama's stomach while they sewed it back up. Fallopian tubes, ovaries, and all.

A few hours postpartum, I was standing next to mama while baby was trying to breastfeed for the first time. My nurse (who had been a nurse midwife for 36 years!!) showed me how she wanted me to hold baby's head against mama's breast in order to facilitate his latching on since mama couldn't hold him quite right because of her surgery. So I basically planted myself there for the next two hours with one hand on the back of baby's head and one hand coaxing her nipple to protrude or pushing against her breast so his little nostrils were clear to breathe. During orientation for this site, my professors said we should allow ourselves to fall in love with the mamas we are working with. And from small talk with her in the morning to giving her reassuring smiles with my eyes in the OR since my mask was on to helping her breastfeed her son for the very first time in either of their lives, I did indeed fall in love with her.

About 24 hours after that, I was sitting at a funeral for a 24 year-old who I have known since he was born too. And today marks one year since Praise died. I'm just finding myself taking it all in, you know? I'm far from uncomfortable with death. I feel like there has been enough of it now - indiscriminate of age or reasons why - it just happens. People die. People are born. Keira was born. Geoff died. Brendon died. Baby boy was born. Still, it's a strange juxtaposition when it happens so concurrently. Just trying to take it all in. "It can open your heart, it can break you apart, and it never even slows down..."

What do tinctures, Tupac, and a barge have in common?

In a word? ... Marin.

My community clinical placement this quarter has me in a county office with Public Health Nurses (PHNs) who work with resident clients on issues ranging from medication management to Adult Protective Service cases to finding housing for homeless citizens. It's a mixed bag out here across the bridge... that's for sure.

I try to err on the side of staying reasonably mum about my impressions and opinions relating to public institutions, places I'm working, and people I'm working with (with obvious exceptions I am WELL aware of thank you very much!!). Regardless, the internet is a very accessible place! So I'll just say this before I launch into what I have been specifically working on: Marin is an enormously wealthy, predominantly white community. Community Health placements are NOT the same as hospital med-surg floors. Thus, the pace... the energy required for a clinical day... the skills one has to draw from... the challenges one encounters... all very, VERY different than my summer on 14 Long. Dig? :)

Every Tuesday and Thursday morning, I wait for my friend Adam's holler from the street to let him into the garage with his bike. We hop in my car and cross the Golden Gate, watching for the glorious spot where the fog line recedes and the sun shines through. And then we do things like... well... meet up with our third half Kate, and show up at St. Vincent's soup kitchen during lunch service. With a bunch of flu vaccines. We set up right there in the cafeteria and two hours later, we walk out 53 flu vacs lighter.

A day later, we were out in the field at a community health fair. Our medication management booth was adjacent to a homeopath who was providing homeopathic flu vaccines. Intrigued as I was by her claims that she could also reverse autism with her elixirs, I did not bite on the homeopathic hook. Adam, on the other hand, abandoned all training, science, and reason he has ever been motivated by and foolishly accepted her tincture tea concoction. Two sips and a burning throat later, he came to his senses and hightailed it out of there. His EXACT words regarding the incident: "It tasted like tingly burning tree bark... It tasted like regret."

One of our favorite experiences was an orientation to Marin City by one of the PHNs who has worked with the community there for-ev-er. Marin City has about 3,000 residents and was initially a shipyard where African Americans from the South moved to work during World War II. The war ended and work dried up, but the community survived. Today it is situated in some of the most beautiful and highly valued pieces of land on the planet, since it overlooks the Bay and is literally 10 minutes from SF. It is filled with a lot of Section 8 housing, is a designated area of gang activity, and doesn't have a grocery store in its vicinity. It boasts the likes of Jack Kerouac, Annie Lamott, and Tupac Shakur as notable one-time citizens. We desperately want to work with the NP at the health clinic there - but it feels like it has been harder than it should to make that happen so I am not overly optimistic at this halfway point through the quarter.

As I said above, we have a number of PHNs that we can connect with to see if there is something we can go do with them. I knew I found a good fit for me with Sean when I saw a full BDU and weapon picture of him in an indistinguishable desert, a huge bald eagle/American flag picture on his computer desktop, and noted he looks like every middle aged detail guy I ever worked with in DC. LOVE IT! Long story short, he works with a community on Richardson Bay called "Anchor Outs" who live on dilapidated boats that they scrape together or buy for 125 bucks. They are totally at the whim of the elements, and have no direct way to get to shore other than inner tubes or dinghies they have. They have a full on community out there though - there are about 100 boats where some people have lived for years. Every winter there are a few deaths due to exposure. There are good guys and bad guys out there, I'm told, and the bad guys live in (drumroll please) THE BARGE. Lots of drugs happening on the barge. The barge is like... the big bully of the neighborhood. Anyway, Sean invited us to the meeting he had set up with the Police Dept's task force on homelessness. In the meantime, we concocted a plan (and YES, Adam, I'm giving YOU the credit!!) to ask the cops to take us out on their boat so we could offer flu vacs and basic health screenings to the Anchor Outs. We met with the PD this week and they seemed amendable to the plan but have some stuff to sort out first. So FINGERS CROSSED that we will actually get a date set for this endeavor and we can suit up in some scrubs and hop on a boat to give some shots! In the meantime, I am practicing the discipline of "letting Marin be Marin."

30 before 30: #14 Indulge in a day-spa package

Two weekends ago, I was spoiled ROTTEN when I got to check the "day-spa package" off the 30 before 30 list. In honor of my 27th birthday, my birthmom Veronica, her two sisters Gloria and Roz, and her mom Mary treated me to an unbelievably relaxing and special day at the Spa at Cache Creek with them.

I have had fun spa treatments over the years at various places, but I had never had the whole shebang at once before. Now I can say... YES, it really is as amazing as it sounds :). We all started with some nice hot tea in the waiting area after we changed into our robes, then got right down to business with massages. Honestly, it's hard not to sound overly indulgent in this post so I will go ahead and take off the band aid fast for you: The rest of the day we spent at the cabana they rented for us to relax at between treatments- so between my massage, pedicure, AND facial, we were sipping greyhounds (or whatever we decided Gloria's special recipe was) by the pool. Oh my lord, it was heaven.

I was feeling so pampered by the end of the day, I almost fell over from shock when we walked into the hotel room and they had snuck in during the day and set up - wait for it - 27 BIRTHDAY GIFTS for me to open. Amazingly perfect gifts - A really nice traveler coffee mug that is fast becoming my morning best friend, gift cards to all my favorite/most used places, a BEAUTIFUL bracelet that Gloria picked out and personalized for me, the most cozy blanket I've ever used, and so many more.

So needless to say, this 30 before 30 blew ALL expectations out of the water. From the spa treatments and the facility itself to the pool cabana to the showering of gifts to the time we spent together over meals (and losing money at the penny slots with Veronica!), it was a very special time. Thank you SO much to Veronica, Mary, Roz, and Gloria for your outpouring of love on my 27th birthday :)

So long, Sweet Summer

Annnnd we're back.

Actually I've been back for over a week now, but have most avoided being behind the computer all the time again. Hence the lack of blog updates.

Bobby came to visit for Labor Day weekend and it was SO good to have him here in SF. He came right on the heels of summer quarter, so I was definitely ready for some fun and R&R with him. Bobby is one of my favorites - always steady, always up for whatever is on the agenda, and always fun and easy to be with. Fortunately he did not drag me out to Alcatraz or Pier 39 :) - Instead his visit included a hike to the bridge, lots of good food, a fabulous night at Arista in wine country with David and his friend from Turkey (with a surprise cameo from Yann and his friend in from NYC), and an AWESOMELY unexpected afternoon of classic rock at the Sausalito Art and Wine Festival.

I spent a handful of nights out in the East Bay on a "STAYcation" with my mom. It's so nice and quiet and relaxing and most importantly SUNNY out there, and I just couldn't leave :). Dad and Julie were out of town celebrating their birthdays at the US Open, so it was just my mom and I there to enjoy some hang out time together with pedicures and lunch and taking the kids to fro-yo.

And then there was Mexico. A little place right on the Pacific. A warm place with no memory.

But before the beach there was la ciudad de Mexico with Patrick. I had the best weekend imaginable in D.F. Patrick is there doing research for a month or so before his next stop in Chile and is living with one of his best friends from his program named Diana (or LA CASADORA/The Huntress to us). Together, Diana and Patrick thought out the most perfect weekend of places to walk, see, eat, and do. Patrick knows me so well and knows how I like to travel and married that with Diana's amazing knowledge of Mexico and the city itself. It was the best "fast and dirty" of an ENORMOUS city I can think of and it was entirely in thanks to their hospitality. Diana is SUCH a cool person - a great friend to Patrick and now to me. I love that they have each other as they wade through their program together! I can't say thank you enough for a great weekend, you guys. The only thing I regret is not finding me a cheesy I Heart DF shirt to remind me of how much I really do LOVE that city.

Of course, leaving D.F. and ending up a few hours later laying by the pool with a beer in hand did not a difficult transition make! I met up with Lo, Jess, Haley, and Sarah at the airport and flew with them to Zihuatanejo - landing in perfect weather, I might add, despite our accuweather fears we would be in thunderstorms all week.

We spent the week at a beautiful house on a small beach my friend Lauren has been surfing at for about 8 years. Throughout the week, the girls surfed at the point and I watched from my favorite reading spot at the house...

Maybe about every other day we had some afternoon excursion down the muddy potholed road in our unimpressive but faithful rental car. Some days just to do a beer bottle swap in Los Llanos, others to my favorite find the whole trip - the Miches Ixtapa stand:

Or one morning when Haley, Jess, Sarah, and I schleped it over to Troncones before sunrise to meet up with a fisherman named Samba to take us out to catch some Mahi-Mahi. Five hours later we had no fish and no bites but we walked away with a lot of sun, a handful of dolphin spotings, and a chance to ride around on a huge Mexican fisherman's boat (huge fisherman, not huge boat) - a win, all in all.

We spent a lot of time talking with (or should I say listening to) Lauren's friend Pato. Anything from pharmaceutical company conspiracies to the benefits of organic farming to dancing with as opposed to fighting against life.  Pato looks like this when he gets in a talking/teaching/preaching mode. And I love it:

To Pato's credit, I specifically said on Day 1 of the trip that no, I WASN'T going to be joining his beach trash pickup group that evening. But by Day 5 or 6? Well... how could I resist that moustache?

On my 27th birthday, we packed a cooler and headed down the beach to Roberto's tent at sunset. We laid in his hammocks and took too much of his good salt and limes and talked too much for his liking, but Roberto sang us some tunes anyway. Some originals, some Dylan, and a Happy Birthday. Roberto on guitar, one of us on eggs, everyone at the chorus.

I've saved the best for last... and her name is Augustina. She and her husband are the caretakers of the house we rented and while they're both amazing, Augustina made the food :). Chilaquiles, mountains of lobster, fresh tortillas at EVERY meal, chile rellenos, fresh fish in banana leaves, tacos al camarones, huevos verdes. Sweet Lord.

Summer 2011... time well spent.

30 before 30: #4 Run a 5k or maybe even a 10k

I've always wanted to be a runner but never really believed it was something I could achieve. I mean, how many runner friends do you have who say "Yeah, I used to hate running too but now 5 miles is nothing." Oh please!

Well... 5 miles still feels like a lot to me, but a 5k? I can do that. I did that yesterday before breakfast :)

When I heard about the Giant Race and getting to finish ON THE FIELD at the ballpark, I knew it was the race I wanted to shoot for to fulfill my 30 before 30 5k. So I recruited some buddies, bought the "Get Running" app for my iphone, and had gave myself plenty of time to get from zero to runner.

I remember every step of the way to get from 1 minute intervals... to 2 minutes... 5 minutes... 8 minutes!! I couldn't believe when I was running 8 whole minutes in a ROW! It makes me feel almost foolish to admit that those were legitimate milestones that I had to train for, sweat for, and discipline myself in order to accomplish.

My most vivid training memory was when I was running outside in Tahoe and listening to "Glorious" by Newsboys, surrounded by mountains and snow and trees and sky and just feeling light on my feet and light in my soul. I remember realizing that I'm not trying to be a runner anymore... that I *am* a runner.

I spent the last few weeks trying to squeeze in training runs between classes and clinicals and ended up with two goals for the race: 1. Run the whole thing. 2. Do it in under 35 mins. I knew with Jenn Kleist at my side with her "Don't Stop Believin' 5k" mix blaring and encouragement flowing, it would be a piece of cake. We all went to the game on Friday night (I never thought I would be praying for a win against the Astros, but good job Giants!) and came back to my house to sleep before the race on Saturday am.

It was FREEZING at the starting line, but Matt Cain (!) was there to start us off down on the south side of the China Basin. The route took us from there around the park by Willie Mays Plaza, up the Embarcadero to the turnaround at the Ferry Building, and back down to the ballpark. Along the route was a gospel choir from Oakland (awesome), a cheer squad (only in SF would there be a 20:1 male to female cheerleader ratio!), and a bunch of family/friend onlookers. I felt GREAT the whole race... just so exciting to be around THAT many people running, running alongside my friends, and reflecting on how far I had come.

To end the race, we turned into the ballpark and were hit with a bunch of cheering friends/family in the stands as we ran along the track to the finish line. I could not stop smiling. Man, what it must feel like to play on that field and look up at the stands at a sell out game! It's so beautiful and loud and energizing. We got our medals... and water, yogurt, bananas, bagels, cliff bars, coconut waters... Timmy bobbleheads... and race tshirts. Yay for swag! There were tons of booths to visit, more runners coming in, and a kids race to watch (so cute!) before we left and went to get a well-deserved bloody mary at 21st Amendment :)

The final results are in and I met both my goals! Definitely ran the whole race and came in at 33:49. Here are the full 5k stats:
Overall: 1290 out of 3466
Women: 612 out of 2129
F 25-29: 181 out of 500
Finish: 33:49 Pace: 10:54

Thoughts on all this:
I'm thankful to my friends who agreed to do this with me and stuck it out from training to finish line. I was so much more motivated in the training I did alone this summer just by knowing August 27th would come and I'd be running with you. So THANK YOU Nicku, Renee, Jenn, Jen, Jess, and Higuera (yay for doing our first race together!).

I'm going back and forth on if I am surprised I did this or not. I feel like I really knew all along I would do it and do it well, but I remain amazed at what we can make our bodies do if we are mentally disciplined enough to do it. Four months ago, I couldn't run a mile. Now I can run 3.1 miles and feel great about it. It's something I have stuck with for no other reason than I set a goal for myself and I wanted to achieve it. So I did. And I'm proud.

Finally, the elephant on the blog is that this 30 before 30 specifically says "Run a 5k and maybe even a 10k." Let's just put it out there in the universe here and now that next year will be the 10k. And I'm STOKED.

Giants will release Pat Burrell... unless they don't!

(Dang... I originally posted this on 8/2 and accidentally deleted it when I was editing another post... LAME! Sorry for the repost! Interesting to re-read the article, though, and realize how much the team has suffered from injuries in even these last four weeks. It hurts!)

The first time I saw Pat Burrell was back when he played for the Phillies and I was behind home plate in my boss' seats at Nats Park. "WHO is THAT" was all I could get out through my jaw hanging open and immediately used my "phone a friend" lifeline to Clint (who is the only person I knew would have the answer since he grew up in Philly). Fast forward three years and imagine my delight at finding out Pat the Bat had traded in his Philly red for Giants orange. Now rewind to last weekend when, amidst all the trade deadline rumors, I was unceremoniously informed that Burrell had been let go and once again used my lifeline to Clint (who I knew solely would understand how my attachment had come to be and how it couldn't possibly be over for me and Pat). 

Well, as it turns out, Burrell hasn't been officially let go. The rumors were bad, preemptive reporting. The blog post below from McCovey Chronicles gives the best analysis I can find on the issue but the reality is (and it pains me to say)... I think we may have indeed seen the last of Pat the Bat taking the field in San Francisco. 

Giants will release Pat Burrell unless they don't

By Grant Brisbee

www.mccoveychronicles.com

Last night, there was a good, old-fashioned freakout. It's been too long. The story was that the Giants were planning to release Pat Burrell and demote Brandon Belt to make room for Carlos Beltran on the 40-man and 25-man rosters, respectively.

Belt is never going to play, so that wasn't the reason for the freakout. It's awful that he isn't going to get that chance, but he was never going to get at-bats. Let him get at-bats so he's ready for 2013, because if he can't play over an Aubrey Huff with a sub-.300 on-base percentage, he's never playing over Aubrey Huff. He probably will be the hitter sent down today.

So why the freakout over Burrell? He's a popular guy, sure, and I'm sure he's the biological father of some of the readers here, even if they don't really know that yet. But he's just a fifth outfielder -- a low-average, master of the three true outcomes. What he did last year will never be forgotten, but I'm okay with him on the bench. Break out the wOBA charts if you must, but he's an atrocious defender, enough to break a tie between him and Ross, Torres, or Schierholtz.

Here's my best explanation, then, for the freakout:

This site, myself included, is filled with people who probably take the Giants a little too seriously.

Haha, just kidding. That can't be it. Here's the real explanation:

Over the next two seasons, the Giants will pay Aaron Rowand and Pat Burrell combined $25 million. If they release Rowand, they pay $25 million dollars. If they release Burrell, they pay $25 million dollars. This is what a sunk cost is. The Giants know this. Dave Roberts got paid millions of dollars to announce post-game shows for the Red Sox in 2008.

The question, then, is who would help the Giants more as a fifth outfielder? The money's gone. Poof. It ain't coming back. By allocating more of the money to one of the two players, you don't get a better player. So look at both players and how they fit on the current roster. The Giants have:

Cody Ross*
Andres Torres*
Carlos Beltran*
Nate Schierholtz

The ones with asterisks are the ones who can play center. Well, that's not quite true. Nate Schierholtz can play center too, the Giants have just never tried him there. Ross and Torres are center fielders. Beltran isn't any more, but he could cover in a pinch. So for the Giants' fifth outfielder, what's more important?

1. A player whose value is entirely dependent on playing center field
2. A player whose value is entirely dependent on hitting home runs and taking the occasional walk

It's not a trick question. They're making a combined $25 million no matter who you release. They both have their very specific uses. But which skill set do the Giants need?

Burrell, no question, is a better fit. Rowand is done as a hitter -- almost nothing stabilizes quicker than strikeouts and walks, and over his past 633 plate appearances, he's struck out 136 times and walked 26 times, hitting .233 with 13 home runs. He can't hit. You can believe in his last 10 at-bats. I'll believe in his last 600.

But if the Giants get rid of Burrell, we're going to see a whole lot of Rowand late-inning pinch-hitting roles. He'd be the guy, the bat off the bench. Venters, Kimbrel, Madson, Bell, Adams ... Rowand. Whiteside bloops a single against Huston Street, and ... Rowand. He'd be the outfielder equivalent of carrying three catchers.

It wouldn't be a crippling move to keep Rowand over Burrell, and it wouldn't undo the improvements of the Beltran trade. It's just disappointing because the Giants wouldn't stay as good as they could have today, never mind the sentimental attachment to one of the reasons the Giants even made the playoffs in 2010.

Strip away the emotion and the subjectivity, and it's still pretty clear that Burrell makes for a better 25th man on the Giants than Rowand. I'm not saying Rowand needs to go (just hinting!) but if it's a choice between Burrell and Rowand, I don't see how that's a choice at all.

Nursing Firsts

 So far this summer, I have felt the nursey-posts have almost written themselves. I have not had to look very hard for inspiration or relevant anecdotes. But I've hit a little writers block these last two weeks and I think I'm finally ready to publicly admit why. That is... that I really f***ed up for the first time with a real live patient.

I'm a little (a lot) reluctant with the details but suffice it to say it was a perfect storm of my novice judgment, the nurse I was assigned to being wrapped up in a different patient's emergency (seriously a crisis... we figured out he was having multiple brain hemorrhages), and feeling so so bad that such a nice man was stuck with me and my unpracticed technique. So, I screwed up... did some due diligence with RN-informing and charting... texted my go-to friend and also a heart-group-nursing-student buddy for immediate intercessory prayer (CRB and Dailey - you did good... thank you)... and went home utterly dejected and terrified. I crawled under my covers with a glass of wine and cinnamon puffins and spent the whole night indiscriminately tossing them into my mouth and praying for God to cover my ASS until I could get to the hospital the next morning and ensure everything was fine. And it was to be fine, so... God? Thanks for covering my ass.

And also another shout out to God for redeeming my mistake SO much that I ended up doing my very first SQ injections on this same patient (yes... he still let me touch him the next day!). Injections... oye! Such a rite of passage. I actually also didn't do the best job on the heparin SQ either but... what can you do? I'm learning and sometimes (most times?) with nursing, you have to learn the hard way.

I feel like I want to say more about this patient because I will remember him for a long, long, long time to come. He was Spanish speaking and NOT ALTERED MENTAL STATUS (!!!) - such a treat to have patients who aren't AMS once in awhile (right Alyssa and Camie!?). He had a bunch of things going on with his health, but they all boiled down to diabetes-related amputation of his toe not being enough to fight the gangrene and he was facing a decision to amputate below the knee. His son never left his side and served as his dad's interpreter to the point where the son went through a medical interpretation program to better assist in his dad's care. They just... ugh... are wonderful people who wanted me to learn, appreciated my effort to speak Spanish and laugh at all my gringaness, and reinforced the valuable lesson to ALWAYS listen to your patients and include them in their care process. It was a life-giving student nurse opportunity - one that RNs can't always enjoy because of the constraints of having four patients who need intense individualized care. (For any curious readers, the patient declined the amputation and went home with heavy antibiotics and great hope they would work miracles. Barring a medical miracle or a mind change, it is likely he will decline very rapidly over the next few months and ultimately die from the gangrene and other co-morbidities). 

So maybe this is a post about nursing firsts. Over the last two weeks, I gave my first meds (literally about 50 tabs to a non-complaint AMS patient who I ultimately won over by the end of the day - WIN!), gave my first IM and SQ injections, did my first central line dressing change, gave like 20 meds through a G-tube, really felt like I took care of a patient semi-independently with nursing process and goals for the day, had a patient die before 9am, had a patient who asked me to call him "Romeo", and as mentioned.. really screwed up for the first time.

The Faith Rx

Last week I was sitting at one of the cows (name for the random computers that seem to always end up in a different corner of the hallway day to day) fiddling around on the charting system called UCare when I heard the patient in the adjacent room just straight up crying her eyes out. I leaned back in my chair enough to peak in and see her laying in fetal position, shaking from tears and pain. Her nurse was on top of giving her pain meds according to orders, but they weren't reaching her abdomen with enough strength to combat yet another ERCP for chronic pancreatitis.

Twenty-four hours later, she was still in the middle of a major pain crisis when I was assigned to helping with her care. One of my favorite roles of a nurse is a patient advocate, but as a student nurse I don't have the ability much less the experience to know when recovery is running its normal course versus when a doctor needs to step the care up a notch. The RN I was with felt it was the latter, and went to work trying to get the dosage right for the patient to achieve SOME degree of comfort.

Somewhere amidst this back and forth of pain management, the patient's description of the pain turned into the implications it has had on her life. Her husband always worked so hard, she said, and these were supposed to be happy retirement years... to travel and enjoy this life he made for them. Her garden would be ruined by the summer heat by the time she got home. Simple things, perhaps, in comparison to her anguish from praying over... and over... and over for God to take her pain away. God isn't listening, she said. She's all prayed out. God isn't listening. She's angry and she can't pray anymore.

I think one of the unteachable nursing "things" is what kind of Rx to give a patient who has lost their faith. Because we all bring OURSELVES into this profession, right? We all bring our experiences, our beliefs, our... US. So, never being the laying-hands-missionary-type myself, I was quiet. Something about every response I could think of was so wildly inadequate. I mean, what? God's going to heal you completely and you'll be in Bali in no time! No. God's given you this burden because He knew you could handle it! Double no.

Funny how God DOES give us grace for the moment though. The only honest thing I could think of to tell her was that when we feel we don't have another word in us for God, God puts people in place to speak a word for us.

The chaplain was in the room within about 5 minutes of contacting him (they're amazing at UC - I hope they're amazing at all the sites and not just at the fancy hospitals) and I can't begin to describe the peace the emanated from her spirit after the visit. Her pain was still acute - and would be, I heard, for days after - but I looked through her charts this week and saw that she had daily visits from the chaplain from that point on that were described as meaningful and comforting.

And to me, the faith Rx is leagues more meaningful and comforting than any physicians orders or nursing intervention I am training to handle.

Week Five

Week five felt a little easier: 5am wasn't so early. Respiratory rates didn't take so long to count (or even to remember to take in the first place for that matter). I didn't have to use my cheat sheet to find the code for the bathroom, pantry, utilities closet, or coat room. My love/hate with the thermometer-taker subsided. My string cheese, handful of wasabi wow trail mix, and protein shake is the perfect combination of calories and quickness to keep me running for the shift. 

Week five was exciting: During the morning shift change, I found out one of my patients was getting a thoracentesis that morning and I all but got on my knees and begged to be able to watch. A huge long needle and catheter going into the pleural cavity through an intercostal to drain some nasty gross fluid accumulation out? Yes please! My patient was a 68 year old woman with a long history of meth use who had just found out she had cancer in her liver that is ultimately going to kill her. Whether it was the meth or the cancer I'm not sure,  but her right lung was completely diminished thanks to about 3 liters of interpleural fluid surrounding it. She was a sweet, sad woman who was only then realizing the extent to which she ruined her body... and her life, it seemed, by the conversation I overheard when her 30+ years-estranged daughter called on the phone. The doctor who came to do the procedure was happy to let me watch and when he cleared it with the patient, her one request was to ask if I would hold her hand. Sweet, sad woman. Her little lung came up on the ultrasound - both lobes visible. Three needles, one incision, and a 1L bottle full of tea-colored fluid later... she laid back to recover and I simply had to tell her that I know she felt like crap, but hell if her hair wasn't looking like the day she last got it did. Sweet, sad smile. 

Week five was a win for the English majors of the world: A patient in for another all-too-frequent ERCP was counting down the minutes until her husband showed up so she could discharge. To pass the time a bit I prompted a conversation about the book she was reading next to her bed. Guess whose bed that book is living by now? I'll let you know how it is in my next installment of book reviews ;). 

Week five was a lesson in what not to do when it's time to let your parents be in comfort care: Well. Actually that's that really what the lesson was here, but I'll go with it for now. A son in grief over his 80-something year old mother's deteriorating condition was constantly attempting to feed her despite chronic aspiration and extremely impaired alertness and orientation. He wanted normal routine vitals to be taken, nutrients to continue, morphine to subside. He wanted attention from the Attending. None of the "young doctors" to treat his mother back to health. This difficulty is not really a nurse's burden to bear (although of course we are involved and drawn into the discussions... and, possibly, have a voice with the family where the doctors are unable ). It was sad to watch all of the wheels come off like that when there was so clearly a way forward towards making her comfortable. The importance of THAT lesson is only going to become more underscored as I experience it in my own sphere. But the real nursing lesson for me this week is there are few things more beautiful than when a palliative patient is resting comfortably. I must have stared at her for minutes at a time for signs to tell me what would make her head relax more...for her breathing become less labored... her arms and legs supported... her fingers interlocked. She mumbled indecipherably to me through closed eyes when I said good morning the second day I had her as a patient, but I knew that she understood all that was going on around her. And at least for the times the suite was quiet and there was no family or doctors to squabble over care plans, she was peace-filled.

Week five left me in awe of the era of medicine we live in: The PICC nurses let me watch them put a new central line in for a patient downstairs. We don't get much of those on my floor, so this was a real treat that my clinical instructor Angel totally hooked me up with. I want to explain this whole process step by step, but this post is starting to feel wordy. Suffice it to say... I'm sure I looked ridiculous in my sterile hat and mask, but as I watched on the ultrasound as that tricky little wet noodle line got pushed in from the arm and across the shoulder... chest... and paused before registering its decent down into it's new superior vena cava home, I felt overwhelmed with gratitude for this art of healing through science. 

Week five reinforced that life is not fair: My first glimpse of my 18 year old cancer patient was walking in on him halfway off the bed, supporting himself up with one hand over a yellow-gatorade-vomit-soaked sheet on the floor. 6'1, good muscle tone, not one strand of hair left anywhere on his body, pale as all get out, and a smile to make you forget about the grapefruit sized tumor on his knee. I can't really talk about him more than this other than to say I think it's bullshit that an 18 year old kid is stuck in a dark boring hospital room during summer watching crappy daytime tv to pass the time when he wants to be out in the world trying to become something "cool" like a criminal investigator. It's unfair. Even for a dodger's fan. 

And lastly, week five made me realize I want to work as a registered nurse. Not as a CNS, not as an NP. Those roles will come, surely. But I really want to work as an RN along the path to getting there. 

Thank You Note from Hannie

BEST thank you note EVER! Oh my gosh I cannot stop laughing. Remember the days when 8 bucks and one to grow on might as well have been a million?

WSP: A Look Back...

I'm flying out to DC tomorrow to see my dear friends Sean and Shana get hitched - and it has gotten me thinking about how SIX years have gone by since I first met this band of crazies. It all started with my Semester at Sea roommate Liz who did a semester in DC after we got off the ship. Almost all my DC friends (except my gays and coworkers) come from some connection to that initial WSP 2005 group (which we affectionately called The Bartlett Administration at the time - and of which Sean was/is POTUS and Shana, then, FLOTUS). Anyway here we are 6 years later, and I couldn't help myself from going back through pictures now that I have some back from storage and realizing how it feels like EVERYTHING has changed, NOTHING has changed, and... above all... how often we were in costume.

This is the earliest group picture I could find, but I definitely remember pictures from the EOS apartment days and the "tiki" party someone threw. (Does anyone have those? Send them to me and I'll add them!) Anyway I believe THIS Halloween was at Callanan and Erika's apartment in somewhere VA, right? PS Who is that blonde girl next to Liz? What man did she belong to? 

 

These pictures are from right after Liz, Rachel, and I moved into 548 - was crazy hats not the first party we ever threw there?? I think it was...

Of course the next right move was to evolve in complexity from hats to full-on 80s, which we did QUITE well. What I remember from this night is setting up a PROJECTOR in the living room to blast 80s music videos on. And streamers. Oh my god I worked for EVER on those twirly streamers all over the ceilings. I also remember Steve "Big Guns" Allen and his Navy buddies showing up in normal human clothes and proceeding to raid Liz's wardrobe for "80s" looks. And, as always, flip cup in the kitchen and Callanan ending up amongst the trash. 

Shamrock Fest. I want EVERYONE to know that I really REALLY restrained from publicly revealing the pictures I have in my arsenal from Shamrock Fest. I think we made it to two Shamrock Fests as a crew and I cannot stop laughing at why that was deemed the BEST POSSIBLE TIME for Muffin's homemade empanadas to make their first entrance. Also noteworthy - remember when POTUS and Muffin like legit RACED up that stupid climbing wall in the middle of the parking lot? Good GOD.

 

Another Halloween - at Muffin and Sweeting's place near H St. Corridor. I. HATE. HALLOWEEN. But I think I finally was a good sport and put on like a Minnie Mouse costume at the last minute. Regardless, Roman's costume definitely takes the cake on this one for me. And also this is where I first start seeing Tiff show up in pictures! (Other than Memorial Day in Orient... which I can't find my pictures of!) 

Ok now for some nice ones... Birthday in Monticello, TRADEMARK picture of us on the barrels on the North Fork, Cute one of Liz and I on the Speaker's Balcony, and a Family Thanksgiving Dinner shot (in an effort to represent ALL the MANY family meals we enjoyed together... even the all-out Christmas Brunch where we had the unexpected Fire Department guests show up. Oops.) And OF COURSE the last time we got all gussied up for Phil and Tiff's wedding :)

I'm sorry if this post feels disjointed or exclusive to those of you who don't know anyone in these pictures... but for me it is amazing reminder of the history I have going into the weekend ahead with these dear friends. Having TOO MANY hilarious pictures and memories to chose from is one of the best problems I can think of to have. All of these memories are made even sweeter when I think about the last time I was in DC which was for the trial (and wouldn't you know it - the only picture I could find from that trip was one of Muffin drinking BOONES (!!!!) on his couch after the trial went in recess for the day). All of these friends (including others outside DC, specifically Clint who has actually been by my side for three years longer than WSP friends) have been there from the morning we found ourselves in the hospital waiting on Rachel to wake up... to showing up at 548 to help move us out around the horrific scene the house had become... to supporting us in dealing with the media and detectives and laywers... to sitting in the court room EVERY DAY of the trial despite needing to be at work. Well.. happy days are here again, Bartlett Administration! It is going to be a GREAT weekend of celebration and I cannot WAIT to see you all.

UPDATE: I just found these that are either relevant to the aforementioned memories OR just couldn't be left out... Disfrutan!

The climbing wall at Shamrock Fest... WITH MUFFIN AND POTUS en route!

Muffin and his empanadas!

I found Orient pics! 1st comes love, then comes marriage, then the baby in the baby carriage = Phil and Tiff

How does one comment on perfection such as this?!

POTUS and FLOTUS

Orient, NY. The most relaxing place on earth because there's nothing else to do but relax.

Or make out with guys in canoes... (You're welcome!)