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!)

A New Axiom

Two tests on Wednesday of this week had the whole cohort spun up into a tizzy. It can be said that our type thrives on stress, so maybe that's what contributed to the tension everyone created for themselves. All that talk had me in a semi-panic when I realized how much I took to heart the idea of "balance" in this craziness and didn't study at all during 4th of July weekend. Yet from that temporary psychosis, a new axiom emerged: The most important thing is to become a kickass nurse.


But part of getting to that place is the growing pains of not being there yet. Not even close. I forget to count respiration rate on vitals all. the. time. Then what?! I've just been faking it on the charts. I even got semi-called out (in a nice way) by the nurse I was with this week and I still faked it. UGH! So stupid. I also have "student nurse" insecurity - I hate making the patient wait or try again just because I'm retarded! So embarrassing. *SO* humbling.

I've just never been challenged like this before. I've always been good at what I do or stayed away from what I suck at. This whole process is a blend of those two. Because of this, I am grateful to have some life experience and a not-fresh-out-of-college maturity level to fall back on. I'm OK with my weaknesses to improve on. I'm even okay with them being publicly exposed! The most important thing is to become a kickass nurse. 


On the floor this week, I recognized a family member of a patient about to get discharged into hospice care. Suffice it to say that was bizarre for both of us, but ultimately a great reminder that this work is not isolated. The patient probably has another week or two in her so for now the highest priority was pain management. She was in a lot of it. But the PCA and I began to give her a bed bath anyway - gently with the warm towel over her swollen legs... firm grasp over her shoulders to roll her on her side... whispering encouragement that it was almost over... loosely locking my fingers in her hand as we waited for the EMTs to ready her transport. She was not able to formulate many words between her drowsiness and difficulty orienting herself, but she offered a decisive "thank you" before she left.

I hope I'm the kind of nurse who will always consider it a privilege to participate in personal care. For now though, I hope I'm the kind of student who remembers the most important thing is to become a kickass nurse.

The Type of Life Being Led

Harold: What is wrong with you? I don't want to eat nothing but pancakes, I want to live! I mean, who in their right mind when given the choice between pancakes and living chooses pancakes!?

Dr. Hilbert: Harold, if you pause to think, you'd realize that that answer is inextricably contingent upon the type of life being led... and, of course, the quality of the pancakes


Firstly, let's agree that this quote from the movie Stranger than Fiction from a few years ago (and previously posted on this blog way back when) is hilarious and a comedic high point for Dustin Hoffman and Will Ferrell's characters in the film. It makes me laugh on a basic level... but moreover I love how they scratch up against the concept of how we CHOOSE to live our lives. Doesn't choosing between pancakes or life truly depend on the individual pancake up against the individual life? 


On the floor this week I had patients who have made decisions that have brought them to a place where they just might chose pancakes. Diabetes and alcohol abuse and Hep C and failure to thrive. And I had patients this week who, like Harold, want to live. 


An elderly partially-English speaking patient with beautiful long hair, a husband with kind eyes, and grandkids to get home to came into the hospital with ankle and knee pain. She left with a shiny new walker. I worry about if the walker will serve as more of a hindrance than a help to her longevity as she comes to rely on it more and more. But her eyes were bright, her medication was minimal, and her eagerness to get back to living her life with her family is proving to be more important in patient outcomes than I ever realized. Before she discharged, she told me in broken English that I chose a wonderful profession that will really help people - and to guard my smile and optimism closely. 


Another patient had been battling breast cancer since 1997 and done everything in the medical arsenal to kill it; unsuccessfully. She's one of a very small group receiving experimental chemo treatments now, and came to us because of pneumonia risk. Short of breath, exhausted, weak. She vomited up her breakfast the moment she attempted it, and wearily told us that that hasn't been a symptom for her until this new therapy. The chaplain was doing rounds shortly after and she invited him in for communion while I was in there for vitals. I made myself scarce in the corner of the room while he spoke the Lord's Prayer over her and I literally forced tears back into my eyes, willing them not to spill in front of the patient. I wondered at what drove her to fight for 14 years like this, but when I heard about her two doctor daughters and saw her teenage granddaughter sitting by her bed later in the day, I understood that the decision was inextricably contingent upon the type of life being led. 

The Furnace

14 Long at the Med Center is 1/3 chemo, 1/3 medicine, and 1/3 palliative care. The chemo side is quiet - doors closed except for the few passers through. Patients in their beds and maybe a family member plinking away at a laptop to pass the time. The medicine hall is kind of a mystery to me so far - some doors are open with daytime TV drifting out into the hallway. Others are closed, but judging from the bold lettered signs next to the precautionary gowns, gloves, and masks you have to put on to before going inside, it's a good thing they are! By far the most activity is on the palliative wing, where family groups are gathered at doorways - allowing one or two at a time in to say their goodbyes. There's a beautiful solarium at the corner of the palliative hall that feels like a crows nest overlooking the skyline and the Golden Gate and the sea. A reminder that life is still happening to all the lookers-out.

So on every Thursday and Friday this summer from 7-4pm, that's where I will be. Struggling to stay out of the nurses way but still learn from what they're doing. Attempting to be useful with the so-far-not-very-extensive skills I learn in lab. Willing my hands to avoid the nervous shakes when I take a patient's vitals. Praying to all things holy that I don't mess up... at least not too badly.

14 Long will force me to put my head down, dig deep, and keep my sense of humor. I don't really know what I was expecting, but I can tell you this: Last week when I was leaning against the wall with a classmate- our eyes wide, our discomfort palpable- I started to giggle. "Welp. I guess this is the furnace," I said, "And we just got thrown right in." 

Little Miss Brand New Start

To say that this week marks the beginning of a journey would be neglecting everything that led to this point: working like it depended on me and praying like it depended on God to get me into an Anatomy class for Summer 2009... realizing that I, too, wanted my life to be about service at Denny Hastert's retirement dinner... trekking to Georgetown Minimed school with Liz in Spring 2007(?)... visiting a rural health clinic in las afueras in San Jose, Costa Rica in 2005. So really, like so many things in life, this is another chapter of a bigger story. A long, involved, detailed, important chapter. 

What I'm thinking about a lot is how God is redeeming so many disappointments through this opportunity. I hated my undergrad social experience at GW - it was a dark, lonely time that I have always carried a chip on my shoulder about. Here I am surrounded by 75 motivated, friendly, helpful, open-hearted, high-capacity people. I mourned the loss of my house in DC - not only the awesomeness of that townhouse and the vicinity to the metro and my walk-in closet and personal bathroom, but also the HOME it was to my friends, roommates, and me. Now my DC peach room has metamorphosed into an SF orange room with roommates who pontificate about the matrices in health care, prove that artist and starving don't have to go arm in arm, and manipulate a bacteria colony into the most delicious fizzy kombucha you can imagine. 

I wore scrubs today for the first time. The khaki bottoms and hunter green tops make us stick out like sore thumbs as people who have zero idea as to what they're doing. I don't mind. I'm proud. I'm inspired. I'm... ready. 

Spring Reads

As luck would have it, I did indeed have ample time to attack my stack of vacation books. I've been really trying to whittle them down before school starts since Lord knows what will happen once I'm in the throes of the 4th Edition of "Understanding Pathophysiology"...

"I feel ambivalent about selling my services in a world where some can't buy them. You can feel ambivalent about that, because you should feel ambivalent." 

"I think whenever a people has enormous resources, it is easy for them to call themselves democratic. I think of myself more as a physician than an American... Look, I am very proud to be an American. I have many opportunities because I'm an American. I can travel freely throughout the world, I can start projects, but that's called a privilege, not democracy." 

A couple of the girls I met when I interviewed at UCSF mentioned Mountains Beyond Mountains by Tracy Kidder to me when I told them I was interviewing for an Advanced Community Health and International Nursing specialty. This book chronicles the work of Dr. Paul Farmer and his home base clinic in the mountains of  (pre-earthquake) Haiti. It is his story, of course, but it also focuses on how Dr. Farmer's methods of combating TB and Multi-Drug Resistant TB have affected the World Health Organization's approach to the disease worldwide. It was a fascinating and timely book for me. Might get a little boggy-downy for the non-medically interested reader, but if you're into the "health as social justice" movement... it is a must read.

Oh my GOSH. The Hunger Games. SO. STINKIN. GOOD. Let's back up... I was poking around the bookstore listening to Sarah and Vinnie (my never-miss-a-second morning radio show) and Sarah started RAVING about the book she snatched from her preteen son and how she read it in one sitting the night before because she couldn't put it down. Since I am quite secure in my identity as a reader, I have no qualms about taking up with a worthy teen fiction series (although I do acknowledge that Twilight was nothing more than a guilty pleasure). And like Sarah, I busted through The Hunger Games at lightning speed. The quick synopsis is this... it's set in kind of a post-apocalyptic America that has been divided into twelve districts. Every year, one male and one female between the ages of 12-17 are selected to represent their districts at the Rockies-based capitol where a HUGE television-ready outdoor arena has been set up for them to fight each other to the death until the sole victor emerges. "Tributes" are required to survive harsh conditions, hunger, limited resources, whatever the Gamemakers throw at them to make it more interesting for the watching world, and of course - each other. That summary should tip you off to whether you should pick it up or not... some people love this stuff, some don't. It's fine. But I am DYING to get my paws on Book Two.

"The moment he walked into the shop I knew he was going to be my kind of trouble. Some people carry a charge, you know - you can see it in their colors, and his were the pale yellow-blue flare of a gas jet turned very low that could explode at any time."

The Girl with No Shadow by Joanne Harris is the sequel to one of my favorite stories called Chocolat. I am a little embarrassed to admit I only saw the Johnny Depp and Juliette Binoche movie and didn't actually read the book. Oh well, the movie is one of my favorites so I still feel protective over my claim on it. I pledge now to read the book. As for the sequel, it's kind of a same main characters in a same same but different situation in a same same but different community. But the sequel's storyline is driven around... well... witchcraft. Was Chocolat the book like this? There are wonderful mystical elements in the movie... was "mystical" actually "occult" in the book? In any case, it's a full-on fact in this book that Vianne is a witch and so is Anouk and also the Vianne-Roux lovechild named Rosette. And it's kind of a "good witches" against the "bad witch" villain story. Ok wow, this really was a weird book, wasn't it? I admit I liked some of the writing and got through it quickly, but if you're going to read Joanne Harris... read The Five Quarters of the Orange, which was wonderful I recall. 

Ok last one. Confession: I haven't finished it. I've been trying to get through it for about three months now. My mom and Linda Carey RAVED about this book and I think they just got my expectations a little too high. So high, in fact, that when I read Roy Goble's "Junkyard Wisdom" blogpost on it (click here!), I was determined to get through the book armed with an arsenal of reasons he was dead wrong about Dr. Verghese needing a major length overhaul. Well Roy... here I am three months later... only half way through... and standing very, VERY corrected. For the record, I echo Roy's thoughts on wonderful characters in a great story. But I, too, cannot get past the wordiness.  

Don't you wanna curve away?

Off to Palm Springs for Kayti and Carrie's "every odd year" getaway!

This year's agenda?
1. Pool
2. Pool
3. Pool

So... a slightly less aggressive trip than our past Jamaica, Europe, or Vegas to say the least. Hoping for a very productive week of reading though!

UPDATE: #15 Paint on Canvas

I presented my work from the semester in front of my painting class this week as a final assignment. So I thought it only appropriate to showcase them here as well - because, faithful blog readers, you deserve to see the good, the bad, and the ugly :)

First, my color chart... which I am quite proud of...

Nextly, my abstract... which I also like but did very early in the semester so want to re-do now that I have some extra tricks in my arsenal.

Annnnnd... my still life. Let's just say it is probably not done, but I am DONE with IT...

This is my landscape, which I did from a picture I took in Tahoe about ten years ago. Pretty crazy, right? 

And lastly, my first attempt at a portrait. I did this one from a photo I found of a Salvador de Bahia, Brazil woman - one of the gorgeous black women in the white dresses and colorful head dresses that sell street food in Salvador. I need to make her skin tone brighter so she doesn't recede into the background so much. 

A Napa Birthday for Nicku

I've said before in this blog that one of the sweetest blessings of this last year is my heart group. Those eight women have been a source of encouragement, support, prayer, commitment, growth and LOTS of laughs.

So when one of us turns 30... it's time to break out the heels and good pearls! Nicku planned a BEAUTIFUL birthday celebration on the Napa Wine Train last night with family and friends both local and visiting from out of town!

The birthday girl is someone who is always quick to respond and up for anything. She is my res-walking, bachelor-watching, puppy-sharing, soul-disclosing friend. She is willing, introspective, social, enthusiastic, supportive... and girl has got some TASTE!

Wishing you love, friendship, and blessings unimaginable in your 30s, Nicku... so glad you are in my life!

Hiking Season is BACK

And in the words of Jenn Kleist, "We're going to kick that mountain in the FACE!"

My light blue Camelpack has been my trusty solo-hiking companion for over four years now. I keep some basic safety stuff in there like a compass (along with the directions on how the use it since I have no clue whatsoever), a whistle (to ummm... scare away animals?? make known my wilderness location to rescuers??), some mostly-blister-fighting-first aid items, gum, and a lighter. I used to carry a dinky little swiss army knife but after seeing 127 hours, I'm convinced I need something much more heavy duty in the event I need to cut off my arm. (Seriously. I could have to cut off my arm sometime.)

My Merrells are a little snug but I don't think I'd like them bigger either. I usually download some Sarah and Vinnie podcasts, peruse www.bahiker.com for a game plan on what hike to take (I HIGHLY RECOMMEND that site!), load up on almonds/snap peas/Luna bars, fill up my hydration pack (which is leaking/sweating by the way... I guess I need to visit REI for a new one), soak myself in sunscreen, and GO.

I did two different Las Trampas Regional Wilderness hikes recently - I started both in the main staging area off Bolinger Canyon and went right through the cattle gate up to the Las Trampas Ridge trail to the peak for the first hike. For the second, I went to the left and followed the Elderberry Trail up to the Rocky Ridge Trail and back down through the Cuesta Trail. There are some great elevation-change butt burners on both but more treacherous is the INSANE wind coming off the Bay for the mile or so you tightrope walk along the Rocky Ridge that has views of Mt. Diablo on one side and the Bay on the other. Of course, I'll take some wind over the 100+ enormous grazing COWS I had to navigate through on the Cuesta Trail. Sometimes I could walk around them but if they were in a tree grove on a narrow trail, suffice it to say I was like Vicki from Parent Trap banging sticks together to "scare the mountain lions."

This weekend, I joined Jenn Kleist and Rachel Higuera in their first hike of the season at another BA Hiker-recommended hike at Mt. Diablo State Park. We started on the Ygnacio Valley/Clayton side of the mountain early on Saturday morning.

It was definitely chilly, but we were glad to beat the trail-ruining rain last night! We started at a neighborhood trailhead to avoid paying state park entrance fees and did a 5-ish mile modified loop along Donner Canyon and Cardinet Oaks trails. There was a 550 ft to 1700 ft elevation change to add some challenge, but we made awesome time and felt amazingly invigorated. Cheesily enough, we even appreciated some of BA Hiker's info about the foliage and geology along the trail.

When I hike around here, I am further reminded how special of a place California is. It's unbelievable to me that I live within 10 minutes of some amazing state parks with full trail systems that are surprisingly well kept and used. The views from summits don't disappoint... and the friendliness of the hiking community certainly doesn't either. So get your butts moving, people! Not all of you are lucky enough to live where I live, but I challenge you to find the trails in your area and kick them in the FACE!