RN

It's obvious I have been taking an unscheduled break from writing - suffice it to say I have been absolutely basking in post-NCLEX, officially RN licensed, dont-have-to-be-by-a-computer-for-anything glory. I do want to whirlwind through the final main events that led to here, however :)

My last quarter of MEPN was split into two rotations: Pediatrics and Psychiatric Nursing. My Peds rotation was at Children's Hospital Oakland on a surgical unit. I was very happy with that clinical placement because I've spent my whole life driving by that hospital, and as a kid I really liked the huge blow up rubber ducky they had on top of it to advertise for one of their annual fundraising events. Plus, since going into it I was fairly confident I won't be devoting my nursing career to working with children, it seemed cool to me to be getting my experience with that population in a hospital devoted entirely to it. Note that now, a few months later, I remain confident I will not be devoting my nursing career to working with children :).

Our rotation included both clinical days on the floor (where I saw everything from kids involved in major motor vehicle accidents to dog maulings to complicated congenital conditions) and also observation days (where I saw everything from MRIs/CTs to palliative/respite care patients at The George Mark Children's Home to completely healthy/happy/carefree-minus-a-knee-boo-boo kiddos at play during "water day" at their daycare). Definitely a valuable experience, but it was difficult to transition from the exciting pace of MedSurg that I am so drawn to. Plus - and this may or may not go without saying - but it's not usually the kids who are the difficult part of pediatric nursing... it's the parents ;). BUT I embraced the rotation nonetheless, as evidenced by my FLOWER AND BEE ID BADGE HOLDER bought especially for the kiddos. It was a real hit.

On to psych... Psych was a four week intensive (although I think it's safe to say the whole year was intense!) and my placement was at an outpatient clinic in the Tenderloin that serves mentally ill clients who are considered "high users" of inpatient/emergency psychiatric services. They are eligible for the clinic's services because they have been stabilized enough to live safely in the community provided they are given ongoing (usually daily) attention by their case managers at the clinic to manage their medications, finances, and other daily life-type things.

My experience through the psych rotation was transforming for me in intensely personal ways. I was given the freedom to interact with and observe any client who was "available" (emotionally, conversationally, what have you) in the milieu - which in this case is a common area that includes a cafe where the regulars drift in and out of all day everyday. I went into the rotation with fears for my safety (irrational, yes) and concerns for my ability to be a professional in an erratic and unpredictable environment given my personal history. I left having developed sincere compassion for my clients, a skill set on how to assess/manage psychiatric and/or substance addicted individuals, and an overwhelming understanding that mental illness leaves people extremely vulnerable.... and I as a provider MUST advocate for their protection and defense. It's all very serious of course, and I mean what I say and then some... but I would be totally remiss not to include the fact that Adam stepped on human feces (which is a constant sidewalk hazard in the TL!) on one of our last days there and his otherwise wearable shoes became casualties. Understandably.

 

In early June, we actually crossed the MEPN finish line and got PINNED! The pinning ceremony is an old-school nursey tradition. It was a culmination of a long year of hard work that included everyone out of their scrubs and all gussied up with family, friends, and faculty present. There is no question that we all looked AMAZING for once that night, but of COURSE this is the ONLY PICTURE I have to show for it. What to say? 

All year it felt like we JUST HAD TO MAKE IT TO JUNE. But then we got to June. And we quickly realized how NOT done we were. Enter the National Council Licensure Examination for Registered Nurses aka NCLEX-RN. Studying for NCLEX looked like this:

And this:

And got sick and neurotic like this: 

And absolutely HAD to sometimes look like this:

And it even went to extremes like this:

But I got through it thanks to encouragement from my roommates like this: 

And because of try-to-be-a-normal-human study breaks with LB, Saro, Lo, H&J like this:

And indeed at the end of the three weeks of studying, I knew the core content for the test without a doubt and without hesitation y'all (that's a free tidbit for your enjoyment from the Alabama-based test prep class). My palms were sweaty for the first time in my life as I scanned my hand in to take the test at the scary high tech center. But I was shoulder to shoulder with about ten other MEPNs who had by chance signed up for the same test location and time. And just as we had done for the entirety of the last year, we got through it together... And celebrated with drinks afterwards :). 

Last week I woke up to a text that proclaimed me an official RN per the CA Board of Registered Nursing website. Go ahead and look for yourself and enter my name into the "license verification" search if you want... it is OFFICIAL! Carrie Elizabeth Shaffer, RN. I'm not going to lie... I really. really. really. love those two little letters.

The humanness of it all

I had a patient during MedSurg in February who was getting worked up at UCSF after 3 months of trying to find answers for a cold that just wouldn't go away. He was anxious and bored, which sucks for a patient but is GREAT for a student nurse. I may not be able to push morphine, but I can shoot the shit with the best of them :)

After I got my morning stuff done, I remember pulling a chair up next to his bed and chatting about why he was there and what it felt like to be waiting for what probably wasn't going to be good news. Sometimes patients don't ask enough questions and don't know what is going on behind the scenes with labs and tests... not so for this guy. He was on top of it. I love that. He told me about his wife and sons... and about a book he was reading since he was bored. Something about letters and World War II, he said. My head jerked up and I loudly exclaimed, "GUERNSEY LITERARY AND POTATO PEEL PIE SOCIETY!!!!!!" He thought I was totally nuts for getting the book reference, but we were friends from that point on.

I watched his labs and progress notes come up on his chart for days - it took them a long time to diagnose him with a form of Leukemia called ALL (or was it AML? I can't remember now). He started chemo almost immediately but stayed on the Heme-Onc annex rooms on our floor instead of moving downstairs to where Oncology patients typically stay. I peaked in on him often - sometimes a quick visit between classes or just a place to hide during my clinical days to take a break. I learned the hard way NOT to forget to say goodnight to him before I left the floor - it cost me a Jamba Juice delivery to get back into good graces :)

In the middle of chemo, he was going a little stir crazy and would circle the halls over and over and over again with his IV pole wearing a gown and a hat. I'd do a couple laps with him sometimes and he'd tell me that it was "like Nam in here" and he was going to use his pole to bowl over the Med students who always stand in huge clusters in the hallways and totally block them up. They don't move for nurses OR patients, apparently. I can't say I discouraged him from going for it haha.

I received an email from his wife last week saying he was back at UCSF and not doing well. I wrote her back asking for an update and what floor he was on so I could visit, but a few minutes ago I received a reply from her saying he passed away last Friday.

Last Friday. About 3 months since diagnosis. About 6 months since symptom onset. It's robbery, really.

I wrote his wife with a few stories and thoughts and appreciations for what he gave to me as a nursing student and as a person. There are many despite such a short time frame - but... that's why I love this profession so, so much. Immediate intimacy with patients. The ability to ask any question and be trusted completely. The humanness of it all.

So I've been crying and reflecting for the last hour and feel profoundly grateful to him for letting me in on what he didn't know would be his last months. And I want to share what makes me cry the hardest and feel the deepest gratitude even though it feels private and vulnerable: That man never let me leave his room without telling me - all jokes, all laughs, all light-heartedness aside - that I was going to be a great nurse. And he made me FEEL like a great nurse. In this year of being wrong SO much and doing things inefficiently ALL the time and not knowing when the day will come where I won't feel so inept... that sincere affirmation coming from that remarkable patient has meant everything.

30 Before 30: #13 Speak Publicly

Thanks for sending this picture, Gaby! 

I guess it was as bright up there as it seemed ;)

Jerry Seinfeld's stand up routine includes a bit about how most people's #1 fear is speaking in front of an audience and their #2 fear is death. Therefore, Seinfeld jokes, more people would rather be dead than be in his shoes on stage.

My #1 fear is actually of spiders, but honestly I haven't done much in the way of public speaking. I have spoken at a SOLD event and read at Kevin and Rachel's wedding and shared with a group of students at church and asked John Piper a question in front of a couple thousand people at a conference and made a five second "vote for me" pitch when I ran unopposed for Campolindo HS senior class secretary. So it's not like I have shied away from talking in front of a crowd but I'd hardly consider any of that public speaking. When I made "speak publicly" one of my 30 before 30, it was my way of challenging myself to practice that skill in a more formal setting when the opportunity arose.

Today I joined three other student panelists in a discussion about nursing student leadership at a Public Health Nursing Conference at San Jose State University. I wasn't alone up there, it wasn't a keynote address, and it wasn't even about a topic I felt particularly confident about since I'm new to nursing and have barely scratched the surface of what leadership in nursing should look like. But I was honored to be asked to participate and was excited for such a no-risk opportunity to try a microphone on for size in front of about 150-200 (?) students, faculty, and nurses.

My hands get shaky when I speak in front of people. It's not from being scared. It's more of a nervous energy; my adrenaline setting in. Today I bumbled and botched the first question I fielded, but after that I calmed down and felt pretty good about my part of the discussion. I got a good chuckle from the audience after I told them I worked for the Bush Administration and that there is nothing more unpopular I can think of to admit to a group in the Bay Area when introducing oneself. Ain't that the truth.

And that's about it for this 30 before 30. It's better to practice now and get more comfortable with the whole thing than later when I'm trying to take over someones job in DC and need to sound qualified and poised, right?

Beekeeping 101

My fascination with bees started only in the last few years during a trip to Arista Winery when I noticed many bees busying themselves in the lavender by the house. I had known there was a hive in one of the nearby trees, but these bees were buzzing in and out of simple wood boxes on the hill. And in fact this was the very first time it have ever occurred to me that bees could actually be *kept*... and by normal people, no less. I've since been trying to convince my friend D'Aun to get bees for her olive orchard - no success yet, but I plan to remain persistent.

This interest has remained pretty under-explored since I moved to San Francisco and took up nursing instead of bees. But last Christmas, my mom handed me an envelope and explained that "kind of a funny present" was inside. It was a groupon certificate for a Beekeeping 101 class taught by Randy Sue's Bee Haven in Cotati, California (about 45 miles north of San Francisco off Hwy 101). So last week, I finally cashed it in and joined about 40 other wannaBEEs (sorry, couldn't resist) in a jam-packed room for Randy Sue's three hour class.

And It. Was. AWESOME. I completely geeked out. I even moved to a seat closer to the front halfway through the class just so I could have a table to write notes on more easily and see all of her show-and-tell goodies on the table more closely. Randy Sue is SO passionate and knowledgeable about all-things-bees and she was quite simply a joy to listen to and get excited with about the whole thing. I learned about everything from creating the hive to getting a swarm of bees to what to expect from the colonies and the roles of the individual bees in them. I learned about what bees like and don't like, and how they are equipped to handle any and all adversities that can effect the hive such as bacteria, pests, and weather. We talked about honey and all of its amazing uses INCLUDING its antibacterial properties - which I can vouch for because we use a product in the hospital called Medihoney for wound care.

Anyway, I will cut myself off here before I get too crazy and into specific factoids. But seriously... one day I will have the last laugh about this when you are all hitting me up for my honey with labels that read - "Too Much Awesome" Honey by Carrie Shaffer, KEEPER OF BEES.

And that's enough...

There are about a million MEPN-related things I could be posting as another week of Med-Surg revs up, but I keep holding myself back from yet ANOTHER nursey-post until I have written about something else first. And the problem is... there ISN'T anything else. It's ALL MEPN, ALL THE TIME. It really is.

At the outset of all of this when they were saying "how intense of a year it is" and asking questions like "how will you deal with the stress", I viscerally remember my inner scoff at what weaklings they must think we are and how this isn't my first rodeo with a high-capacity, time-and-personal-life-consuming environment. Well, MEPN... you win. You're intense. You're all-consuming. I've never experienced anything like you before. I surrender!

I feel like I go to a high-stakes big-kid dorky science summer camp that requires me to constantly haul loads of books, a computer, gym clothes, reusable coffee AND water cups, and snacks to share with my B-team buddies (Who I draw closer to with every week that passes; a wonderful consequence also helped by our post-clinical Friday tradition to commiserate together at Finnegans; and also facilitated by mild clinical-induced hypoglycemia and beers. But seriously, they're wonderful. I have deep respect and gratitude for them. They make me laugh from my gut and cry from my soul and show support in ways I'm starting to realize only nurses can).

So all that to say, I love this so much... but I wish I had something else to write about besides MEPN. And that's enough to make anyone feel a little crabby!

Timshel (Thou Mayest)

I have a patient who knows the names of all the staff who come into her room. She chats about books and pets and her stint as a missionary in West Africa. She can't wait for her discharge transfer to a nearby hospice facility because she will "enjoy every moment of the air and the sun." She smiles and laughs despite her breath being stolen more and more by growing cancer in her lungs. She is a patient who knows how to die; Beautifully. 

I won't forget her for that reason. Because here in America, we aren't allowed to die. We will battle it out right through Stage IV, but we won't put down the frozen pizza and diet coke. We will show up for dialysis three days a week for hours if it means a few more years... months... or whatever, but we won't take advantage of a perfect day to get our legs hiking up a hill trail we live minutes from. We will take 23 different meds from little pop-open plastic boxes labeled with the corresponding time of day and day of the week, but we won't throw our social cigarettes down the toilet. We compromise *quality* of life for *length* of life at all medical treatment costs, but reject the daily maintenance required to keep our bodies thriving. I am guilty of all of these things... and find myself increasingly fearful that we are all heading for care on 14L.

So the peaceful, content, resolved patients like her are few and far between... and they mean a lot to those who typically see death play out in less consummate guises. Her impact was further confirmed to me just yesterday at a super bowl party when I bumped into the EMT who had transferred her from our care to hospice a few weeks ago. There have probably been 50 patients between us since then, but both of us were quick to recall that patient's uncommon grace; quick to recall a woman dying beautifully.

"But the Hebrew word, the word timshel- 'Thou mayest' - that gives a choice. It might be the most important word in the world. That says the way is open. That throws it right back on a man. For if 'Thou mayest' - it is also true that 'Thou mayest not.' Don't you see?...

...I have a new love for that glittering instrument, the human soul. It is a lovely and unique thing in the universe. It is always attacked and never destroyed - because 'Thou mayest.'" 

(John Steinbeck, East of Eden)

A Nursing Kaleidoscope

On Thursdays and Fridays, I set my "harp" alarm for 5am and follow it up with a "fog horn" at 5:15. (I learned the hard way over Summer that the harp, while indeed a lovely awakening, can be easily slept through... and I am still having heart palpitations thinking about racing onto the floor at 0658 with two minutes to spare). I throw on my scrubs and try to do some upkeep to look halfway presentable (it's fine to be schleppy at that time of morning but by a more reasonable hour I'm always glad I put in some effort... even if it's just mascara and pomegranate burts bees lip stuff). By 6am I'm monitoring nextmuni.com for the 6:12 44-O'Shaughnessy, taking bites of cereal between tasking, and thanking my lucky stars I thought to pack my bag the night before. 6:09 rolls around fast and I'm sure my roommates hate me for my clog-heavy dash to the door.

Six months into MEPN, I know there will be a powder blue scrubbed guy at the corner of 6th and Clement in a Giants or Niners jacket depending on the season also waiting for the 44. I know there will be the same lady bus driver and we'll exchange familiar "Getting through! Almost the weekend!" pleasantries. I know four other scrubbed up men and women will get on at 6th and Geary. I lose track after that but once we get out of the park, I notice we are all peaking around the heads in front of us to see if the N is coming down 9th yet... and more importantly, if we can catch it. Half of us make the dash, the other half keep going on to Judah and hike up the hill to the hospital.

On Thursday I made the N, and by 0630 we pulled up to the UCSF stop. I love the moment right after the doors slide open and one by one we clunk down the three steps into the still-dark morning. Me in my green and khaki, them in powder blue, navy blue, and even some hunter green, slate gray, and crimson red scrubs belonging to other providers. Too early and too cold to chat with each other, we move staggered... yet together... from our respective muni doorways, through the most convenient ambulatory care doors, up the first elevator ride of the day, across Parnassus, and into the hospital through the main entrance or through the ED. We are simultaneously illuminated and shadowed under the orange street lights and fog.

That morning I was describing this phenomenon to the only person I will speak to at that ungodly hour, and Clint perfected my initial designation of it as a 'nursing migration'. "It's a nursing kaleidoscope," he counseled. Certainly you have captured its essence the most beautifully, sir.

30 Before 30: #30 Send one handwritten letter every week for a year

In High School, Kayti and Nora used to write me beautiful letters with perfect handwriting and intentional messaging. Certainly not your average sloppy-crinkled-silly-nonsense-notes the kids pass in class. These were elegant and high-sounding. And given to the recipient with the conviction that "the written word is a lost art" and we all have a personal burden to preserve such a rich and important heritage.

Last January 1st, armed with a fresh pack of "carrie elizabeth" personalized card stock and a black pen in hand (always black), I wrote the first letter, made a copy of it, and tucked it into it's envelope for sending. (This is actually a bad example of what the norm of this process was since I wrote my first letter to Jesus and kept it in my folder instead of ecclesiastically sending it into the whim of the cosmos, but bear with me O, Reader).

I had no rules or expectations or plan at all, really, other than to just pick someone each week and write them a note. Oh dear, strike that. There were two loose margins I mentally set for myself: the notes were not to be occasion-driven such as for a birthday, and I would try to say a meaningful thing to the recipient.

For the first seven months of the year, I was fantastically committed. I wrote to friends near (a town over) and far (Paris! Chile!), old DC colleagues, an author I read. I wrote to my parents friends and my ailing mentor from HS and a Lowell Lane neighbor and a childhood friend's dad who started a wonderful film festival in Orinda.

Admittedly, I fell of the wagon pretty hard this Fall. All of a sudden weeks were stacking on top of weeks, and my consistency suffered. But I would carefully count the weeks I was behind, make a mental list of selected recipients, and take the card stock with me to the corner laundromat to grind-write.

And now there are 51 letters out there. If you received a colorful, adorable, whimsical little note card this year with my first and middle name on it, you were one of the 51. I have you all on a list and each of your letters copied and in a folder. This is the selfish part of it, I suppose, because I have incidentally created a 51-entry 2011 journal for myself. I loved writing you these notes, friends. I loved thinking about you and our shared history as I wrote.

Two final (and unrelated) thoughts...
Of course I know there are 52 weeks in the year and I am thus a letter short by admitting I wrote only 51. The 52nd letter has actually always belonged to one recipient, but the letter can't write itself right now. And... that's all this author wishes to say on that matter. What's a literaryesque post without a little emotional mystery, hm? 

Lastly, and importantly... We are indeed a society at risk of losing our letters. The jeopardy the USPS finds itself in is the strongest reflection of this long-arriving paradigm shift. Out of 51 letters sent, I received 5 back. A response on any level was never part of this equation for me, but I am compelled share that pith with you nonetheless.

So... may this be an encouragement to you to splurge on lovely stationery, select your recipients, and share willingly with them as you push the pen.

An Annotated Photography of New Year's Eve

I spotted the ocean

 I watched surfers, like lemmings and then seals

And did not take this for granted:

 Is there anything louder than the whizzing of bees?

It's not a leg lamp, it's a lotus lamp. And now it's mine.

This "return to BevMo" became the main libation:

I exchanged a ball drop for this and a 10:15pm bedtime:

And woke up to 2012.

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.