The Wonderful World of JHH!

Wow... it's weeks like these that make me appreciate being a student at the [#1 hospital] in the country!  (click to the left for the proof of the ranking...) The resources and opportunities that are made available to us as students are quite incredible. I have to remind myself of the unique environment that I'm in and not take it for granted.  Hopkins is on the forefront of new developments in medical procedures and hearing about innovative techniques is more-or-less a standard daily occurrence.  Not many nursing students have the opportunity to witness headline news in the making!

Now onto my exciting recap... as I've mentioned, I'm in my psychiatric nursing rotation right now, focusing most on learning about therapeutic communication and the importance of developing and maintaining a trusting relationship with patients.  Not only that, but I've also assessed how to recognize my own areas of "expertise" as well as limitations and what I need to improve upon as I work through the upcoming rotations.   Having to sit with patients and process with them through their issues is quite challenging - the one thing I've been struggling with is how to keep my mouth shut and let them work through their problems as they talk to me.  My first instinct is to provide a solution - to offer my opinion on how they should solve their problems... and while in some situations it may be important to offer ideas and alternatives, in most cases it will benefit the patients if they come up with their own answers to their lives' problems.  For one, this gives them responsibility and accountability to themselves, but also it doesn't allow the patient to blame us if things don't work out exactly as planned.  It's an interesting balance, and I'm still figuring out how to best help those that I interact with.  Last week, my patient was diagnosed with severe depression (Major Depression Disorder, or MDD) and after a month of outpatient therapy, it was quite obvious he was getting worse.  He was an older man, and he was slowly starving himself... and then his wife admitted him to the ER one evening because she found out that he hadn't been taking his medications.  He is the sweetest man, and it was so difficult to try to figure out a main underlying issue behind his depression.  We then learned in rounds with the physicians that they had suggested the idea of ECT as an alternative form of treatment - Electroconvulsive Therapy.  Many people are more familiar with the term "Shock Treatment" and, in effect, this is what it is... but most people associate this term with an archaic, underground "torture" and I am here to dispel any misunderstandings of what is a very effective form of treatment for depression.  It was initially developed as a treatment for schizophrenia, but doctors learned after many clinical trials that it was not helping as much as they had hoped... and then, on accident, they discovered its potential with severely depressed patients who are not responding to drugs.  In short, the brain does not produce enough serotonin or norepinephrine (neurotransmitters responsible for feelings of euphoria) in those people with depression.  Antidepressants work to stimulate further release of these NTs or work on receptors to keep what NTs they do have in the synapse longer in order to increase the time of activation and response in the neurons (I hope that makes sense).  Although doctors don't quite understand every working biological detail behind ECT, the general understanding is that it induces a grand mal seizure which stimulates the release of serotonin and norepinephrine in large amounts into the brain, thereby acting as a "natural" antidepressant as it is the body's own "natural" response to produce larger amounts of these NTs.  It's fascinating, I think... and I had the opportunity to go with my patient down to his third ECT treatment (they usually have 6-12 treatments in total).  I had time to talk with him before and did my best to reduce some of his anxiety prior to his procedure.  The treatment itself lasted only a few minutes, and was completely controlled - they administer a muscle relaxant in order to prevent the body from full convulsions.  The most incredible part of the entire experience was my interaction with him after the procedure - I had the opportunity to help him reorient, and I talked to him about some of the things we had discussed prior to the procedure (his interests and life at home).  He had been very despondent and withdrawn from our conversation, and although very respectful as he responded to my questions, it was obvious that he was not engaged.  Afterwards, he actually smiled as he asked me a couple questions about my background!  I was caught off-guard... but so pleasantly surprised by the immediacy of the improvement in his affect and mood, however slight it was.  Since that, I have followed-up with him as he has undergone additional treatments and he is making steady progression forward.  We were so excited to hear him talk about how hungry he was as he finished off his entire plate of french toast :]  This is why I love medicine - seeing first-hand how our efforts, no matter the methods, can truly change the lives of our patients.

I'll try not to go into much detail about the next experience... I don't want to keep you here all day!  This past Wednesday in my Faith & Health class we were fortunate to have 3 guests come in to speak with us - Dr. Laura Taylor, a professor at JHUSON who is doing research on how spirituality plays a role in transplantation, a nurse transplant coordinator at JHH, and a recent kidney transplant recipient.  I'm not sure if many of you watch Grey's Anatomy, but I will admit that it is one of my favorite shows, and when they started talking about this specific transplant story I immediately thought of an episode last season on Grey's - only to learn that the writers took this story and rewrote it for the show!  Hopkins really does make headlines... and here are a couple about the story, to give you better background:

Kidney Gift that Kept on Giving

JHH Press Release: 16-Patient "Domino Donor" Kidney Transplant

Wow.  The sheer logistics behind this comprehensive scenario just sends my head spinning.  But it was a success, and all patients are doing well!  The man that came in to talk to us, Mr. Imes, works for the facilities department at the hospital.  His part of the story was touching - the Director of Human Resources, Pamela Paulk, asked him one day in passing if he needed anything, and he jokingly responded "A kidney!" He had been undergoing dialysis 3x each week for 3 years and it was taking its toll... a few months later she informed him that she had undergone testing and was interested in donating her kidney to him!  Unfortunately, she was not a suitable match, so they were thrown into this huge mix of "domino donations."  He ended up receiving his kidney from an anonymous donor in Oklahoma, and her kidney went to another woman.  He was such a humble man, and our class was very appreciative of the chance to ask him questions about his experience.  The transplant coordinator was also very forthcoming with her perspectives surrounding organ donation, expressing that she has developed a greater sense of spirituality after becoming involved with this process.  Her experiences, watching a kidney removed from one person and transplanted into another to see it start up and work immediately, have more or less proven the existence of some higher being.  And it's true - looking inside the human body, it's hard for me to understand how it just "happened" - it works too perfectly to have merely evolved.  But that's my opinion :]  Live kidney transplants have a much higher success rate, but not many people are so willing to give up one of their working organs... even though our body can work just as well with only one!  So to have 8 simultaneous healthy donors come forward in this giant mix, no matter their reasons (whether for a family member or a friend), is just amazing.  Organ donation is an amazing blessing that we are able to utilize, giving a new lease on life for many who have no other options.  I am an advocate for the importance of organ donation, and encourage all to look into the benefits and, most importantly, to discuss it with your families.  The statistics are staggering surrounding organ donation... the list of those needing organs grows each day, but unfortunately many viable organs are unable to be used because people are confronted with the questions of donation in their darkest hours.  These topics of conversation will never be easy to have, but if decisions are understood and made as families, it will be easier to answer those questions if need be.  And that's my soap box moment for the day!

I can't wait for my upcoming clinical rotations... Labor & Delivery starts in a few weeks, and then next semester is Med/Surg and Pediatrics. I can only imagine the experiences I will undoubtedly have!  I feel like a kid in a candy store... I want to be involved with everything, to experience these incredible stories and witness medical miracles as they happen.  I am excited for the chance to see different aspects of the hospital before I make the decision as to which direction I want to head after I graduate.  Only 10 more months...!  Well, I've definitely flooded you with much to read today, so I'll leave you now!  I'm off to enjoy the rest of September, I hope you do the same!

my heart is in Zambia today...

I woke up this morning (after only 4 hours of sleep) to tackle my first Pharmacology exam.  I survived, and was quite proud of how much I seem to be retaining amidst the flurry of information that I am drowning in right now.  Last semester, all our classes seemed to blend and integrate content, so that studying for one class was basically studying for another.  This semester, although it may sometimes be the case, my courses are definitely more distinct and therefore I must divide my free hours to accommodate studying for each of my classes.  Thankfully, the courses I am taking are not too intense (aside from Pharmacology) and all are quite captivating, so it is manageable.  But as I get adjusted to life here in Baltimore, I'm finding it easier to get distracted by the place that I now call "home."  Weekend nights are no longer reserved for endless studying... I love discovering new aspects of this city! Last weekend, I had one of my oldest and dearest friends out to visit and we made great use of our few short days together.  We drove up to Gettysburg and explored the battlefields on horseback, with a guide detailing the immensity of those 3 days as we wound our way through the now-peaceful farmlands.  What a scene to have beheld, I cannot even imagine... I was grateful that we were able to make our way to Washington DC a couple days later to see the Smithsonian's American History Museum, and get a better understanding of the history behind the battle and the Civil War itself.  I feel that since I took my US History course junior year of high school, I have forgotten where this country developed from and what it was founded on... it was a much-needed reminder of the great sacrifices that have been made for us so that we may live in freedom today.  Aside from delving into our country's historical roots, we also made time to check out the National Museum of Health and Medicine.  Such a great experience!  There were a few exhibits on display that I really appreciated having the opportunity to see, especially the one focusing on the work of those who serve in the trauma bays of the ongoing war in Iraq.  Pretty incredible, to recognize and appreciate their efforts.  Another interesting exhibit focused on President Lincoln, and they actually had the bullet on display that had been removed from his head after he died.  Fascinating.  Brenn and I were excited to see the remains of General Sickle's leg... a leader in the Civil War, he was on his horse during the Battle of Gettysburg and a cannonball hit his leg and severely fractured it so that it had to be amputated... and he decided that it should be sent to the Medical Museum!  And so there it remains, on display for us to view.  Interesting.  But after hearing the story while we were in Gettysburg, it was interesting to connect the stories and see it for ourselves.  And aside from all our gallivanting through the educational sights, we were able to visit Annapolis for a day and then wander through Fells Point (my neighborhood in Baltimore), appreciating all that the Chesapeake region has to offer.  We tried to find a place to experience steamed crabs on Labor Day, but unfortunately they were all out by the time we sat down to eat!  We were slightly disappointed... nothing like eating crabs in Maryland!  It was a great weekend overall, and I was so happy to have her out here.  But now it's back to business as usual...

So, the semester has started off relatively slowly, compared to summer.  I'm waiting for the onslaught of exams and assignments, but so far it feels as if they're taking pity on us for what they put us through!  haha.  It has been an adjustment the first couple weeks, but I'm finally feeling as if I have a solid grasp on what to expect.  My clinical rotation for the first half of this semester is in Psych, which I actually feel relatively comfortable in.  My time spent at the treatment facility in Utah served as great preparation for the psychiatric unit that I am now working in.  We spend our Thursdays and Fridays on the floor, and our main responsibility is to interact with the patients as they are going through their day treatments and groups.   I'm not sure what I initially expected... maybe a little more chaos?  But so far, things have run smoothly and we really appreciate the efforts the nursing staff are making to include us in their daily assessments.  I will say that it has been quite of an adjustment for me... dealing with adults who are suffering from mental illnesses is quite different than my experience working with teenage girls.  The most common diagnosis that we have seen is Depression, but we've also had a few patients who are diagnosed as "Psychotic" -- either suffering with Schizophrenia or a manic episode of Bipolar Disorder.  Our daily tasks include meeting with our assigned patients and discussing with them their reasons for their stay (it's mostly short term, averaging from a few days to a few weeks) and their goals for what they want to accomplish and take with them when they leave.  Working in Psych is very different from any other nursing environment, in that we only have ourselves as tools to help our patients.  WE are the therapeutic means to help them -- we can't hide behind our stethoscopes, which definitely left us feeling a little more vulnerable when we walked into the unit on the first day.  The nursing staff has been quite impressed with how we've adjusted to the environment, and it's been helpful knowing that they have a little bit of faith in us!  I love my new clinical group, and appreciate having the opportunity to learn from them during our conference meetings at the end of each shift.  I'm very glad that I decided to do this rotation first, because I feel like I have made realizations about my own strengths and weaknesses, and know what I need to work on in order to provide better care for the emotional and psychological well-being of my patients, no matter what unit I may be working in. 

Now... on to a topic that is very close to my heart.  For those who aren't so familiar with my experiences in the African country of Zambia, I apologize for the lack of background information... but I learned this morning after my exam that beautiful little Carol Zulu passed away last night, succumbing to the effects of AIDS after a hard-fought battle that a 15-year old should never have to endure.  In short, I met Carol in 2006 (and then saw her again in 2007 upon my return) while I was in Zambia with the organization Mothers Without Borders. When we arrived to the Children's Village in 2006, she had only been there a few short days to gain strength and recover after a recurrent illness had weakened her frail body.  She rapidly found herself a part of the family at the center, and the other children welcomed her with open arms.  And she accepted her new place with a humble appreciation for the blessing that God had granted her.  Only a week later, a trip to the clinic confirmed what we did not want to accept - Carol's 12-year old immune system was falling victim to HIV.  Even after her diagnosis, little Carol was resilient - never losing faith in God and His plan for her.  Despite her condition and prognosis, she never failed to acknowledge the many blessings in her life, and she openly expressed her appreciation for the life that God had given her.  She radiated pure joy, and it was infectious. I know she touched the lives of many, and I feel truly grateful for her example and inspiration.  Through her simple understanding and appreciation of her place in this world, I was reminded of what is most important in our lives - our relationships with our family and friends, and how we can give of ourselves to serve those around us.  Pure charity, love and respect for one another.  I will forever carry her lasting impression with me, especially as I venture out into the health care field as a nurse.  And someday (SOON) I will make my way back to Africa, to serve those people that so desperately need the medical attention that we take for granted.  But that's a soap box I'll stand on some other time :]  Here's to precious Carol, who is singing now with the angels in heaven.....

 

back to school... so soon?!

It's a clear, crisp September day in Baltimore and I have just arrived home from my second day of classes at the beginning of this fall semester. It's quite a change from my summer schedule -- my days on campus were long and draining, and now I have nearly an entire day with no agenda! What ever shall I do? No worries, I have plenty to catch up on... I feel like the 3 weeks of my summer break just vanished, with no warning that the end was rapidly approaching. Now I am back in school, and forced to adjust accordingly! I am excited to be starting on the next phase of this program, but I feel like I need a few days to get my brain back in gear. Once I can better process the information that I am supposedly absorbing right now, I will make sure to fill you all in. Until then... I feel it is only fair to share a few stories about my recent adventures :]

In case you've forgotten, I was lucky enough to have the opportunity to travel to GREECE with one of my dear friends from high school during my short summer vacation. Chia still lives in Los Angeles, so we arranged to meet in London and fly from there to Athens. I had a very long layover in London while waiting for her, so I had the chance to go into the city to explore for a few hours. I loved wandering the city streets on my own, taking in the sights - Big Ben, Westminster Abbey, Hyde Park, Buckingham Palace, the Tower Bridge, to name a few. Here are a couple photos from the day's excursion:

[The Tower Bridge]

[Big Ben and the London Eye]

I love cities that have convenient public transportation! The Underground in London is very easy to navigate, and I loved having time alone to explore the city. And I couldn't have asked for more perfect weather! It really was a wonderful way to start out the trip. We had a slight glitch in our scheduling... Chia's flight was supposed to arrive at 3:30, but a 5-hour delay at LAX put her in to Heathrow dangerously close to our departure flight time -- 9:00! We were a bit stressed out, but THANKFULLY she made it - 5 minutes before the gate was meant to close. We didn't want to dwell on what might have happened had she missed that connection, but it could have caused quite a chain of events that we would not have wanted to deal with.

Our first day in Athens was quite the whirlwind - we woke up (after only a few hours rest) ready to see the archaeological sites that Athens is most famous for, namely the Acropolis. We were blessed with comfortable temperatures thanks, in part, to a fierce wind that followed us throughout our trip. I've heard of miserable days spent atop the Acropolis with temperatures reaching 115 degrees... not sure how long I would have lasted in that! As I stood in the shadows of the monumental 2000-year-old structures, I was speechless and in awe. I love studying ancient civilizations, and this era of Greek history was one of my favorites. I tried to imagine life as the ancient Greeks knew it, and pictured walking the grounds of the Acropolis in the year 200 BC. Incredible. I was a bit disappointed to see the construction in process right now - they are rebuilding the Parthenon, to what extent I'm not quite sure... but I believe it looks more impressive in ruins, after all, it is 2000 years old! Can't expect them to remain in top condition after hundreds of battles and weather taking its toll... so I was glad to see it in its, albeit broken, glory.

[The Parthenon]

[The Erectheum]

[The Propylaea]

After the Acropolis, Chia and I took a stroll through a more modern area of Athens, and then we made our way to the port -- it was off to Mykonos! I will spare you the boring details (haha) but the next few days we focused on relaxation by treating ourselves to various fruity drinks as we lounged by the Aegean Sea. Not a bad way to escape reality, I must say... and Mykonos was such a picturesque place to spend our time. White-washed walls with blue windows and doors contrasted against the deep blue of the sea... it was just what I had envisioned when I imagined visiting the Greek Islands. I loved wandering the streets of the small towns, and especially enjoyed the sunsets over the water every evening.









After our few days in Mykonos, we made our way to Santorini - famed for its cliff-side towns and spectacular sunsets. We enjoyed a trip out to the volcano island off the coast and a ride down (and back up) the cliff on the back of the famous Santorini donkeys! It was quite the treat. We ventured out to the black sand beach (black from the volcanic rock) and then marveled at the sunset from the town of Oia at the northern end of the island. I'm not sure what it is about sunsets that just bring a sense of peace and joy to my heart, but it was there, basking in the amber light of the evening sun, that I felt a wave of comfort wash over me. Couldn't have asked for anything more in that moment. The world stood still... but unfortunately not for long, as I found myself back in Athens the next day. Thankfully we had one more evening to decompress, and we made our way up to the top of Lykavittos Hill, the highest point in Athens, to watch our last sunset over the Aegean Sea. After, we met up with a guy that we had met in Mykonos (he had been on holiday, and lives in Athens) for a delicious dinner at a small restaurant. I must say, I am quite a fan of Greek cuisine -- my favorites were grilled octopus, Greek salad, and eggplant salad. Delectable. He had us try a few of his favorite dishes as well, and we were thoroughly satisfied. Then we drove to the original Olympic stadium from the games in 1896, and I was glad that I had the opportunity to see that before I left. That is one thing, of many, that I am truly grateful Greece introduced to the world! And then our final evening in Athens came to an end, and before I knew it, I was sitting back in my little corner nook of my rowhouse in Fells Point. Wow. I look at pictures and remind myself that I actually went... feels too much like a dream! I am so grateful for the opportunity to travel -- helps me find my center amidst the craziness of my reality. The world offers such unique perspectives, and I gain greater understanding of my place in it each time I immerse myself in the diverse cultures of the destinations I am fortunate enough to visit. Wonder where my next journey will take me... Australia? Dubai? Sweden? It all depends on how school goes this year -- next summer I will (hopefully) be doing my transitional program abroad, and I anxiously await the final list of options! But that is not something that I need worry about just yet... I still have two full semesters of class to finish before that decision must be made! So, I will leave you with a few final pictures, and then I must crack open the new textbooks and settle down for some quality studying this evening! Pharmacology - bring it on.