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.