springing ahead...

It's a GORGEOUS spring day here in Baltimore... I took a walk this afternoon through the city, appreciating the warm sunshine as I wandered along the banks of the harbor.  I love this time of year!!  As much as I enjoy winter, the shorter days and decreased sun exposure really affect my mood... I can already feel the shift, and look forward to sunny days that lie ahead!  And if that weren't enough, there are many other things that have brightened my outlook on life, and I'm excited to share that with you :]

To start, I had the great opportunity to observe 2 surgeries yesterday in the cardiac/vascular OR, a result of meeting Dr. Julie Freischlag a couple weeks ago.  It was an awesome experience.  First, I watched her resect the first rib of a woman suffering from thoracic outlet syndrome -- pinching of the nerve/artery/vein that run through that narrow region of the shoulder.  It was a relatively short procedure, and one that Dr. Freischlag is well-known for.  After that procedure, she whisked me off to observe a surgery that had already begun -- CABGx2 (coronary artery bypass graft) with an aortic valve replacement.  WOW.  I walked into an open-heart surgery!  I stood at the head of the patient for 3 hours, transfixed on the scene playing out in front of me... I could see the heart of this man, and watched the surgeons as they meticulously grafted on an artery cut from his leg onto the outside of his heart.  For those who are not famliar, CABG procedures are required for patients who have diminished blood flow to the heart itself, because without that blood support, the heart cannot function to pump blood to the rest of the body.  Usually the coronary arteries are occluded by fat deposits, result of long-standing diet and exercise habits.  (Prevention, people!)  The aortic valve, also a vital part of the heart, functions to keep blood from flowing back into the heart as it is pumped out of the left ventricle.  If not working efficiently, blood can flow back into the heart, decreasing the amount of oxygenated blood that is delivered to the various tissues of the body.  Replacement valves are synthetic -- created in a lab -- that are designed for maximal efficiency in patients that have weaker hearts.  Medicine never ceases to amaze me... even though I've learned about these types of procedures in class, it's something completely different to see it in person.  Anatomy and physiology is somewhat completely predictable, and although there is still much to be learned, it's fascinating to really understand and appreciate all that we DO know.  One of the aspects of Adult Med-Surg that I appreciated most was connecting all the patient data to understand the much larger picture... one that includes not only physiological factors, but also emotional, psychological, environmental, and social factors.  For example, my one patient who was suffering from congestive heart failure and renal failure -- she came into the hospital for fluid overload due to the complications of those two chronic diseases, but with further investigation, I learned that her meals included easy-to-make foods such as canned soup, which are known to be high in sodium... which would further exacerbate her fluid retention.  Interesting what health care providers can learn when they take the time to talk with their patients and learn more about their lives outside the hospital...... which can help us better care for them while they are inside the hospital.

In my last post, I mentioned my upcoming trip to St. Croix... I met with my group and instructor last week to learn more about what we should expect from our clinical experience on the small island in the USVI chain.  Our responsibility focus will be on health screening and health promotion.  The big diseases we will be faced with include diabetes, obesity, CHF, and... HIV.  We have a lot to prepare before we head down there, and I'm excited to research ways to better educate people on the prevention and management of these health complications that plague our modern society.

I'm nearly half-way done with my pediatrics rotation (really??) and this past week, I was fortunate enough to have a charming 13-year-old boy recovering from a sickle cell crisis as my patient.  For a kid who is familiar with the inside walls of hospitals, he was handling his most recent hospitalization with a great sense of positivity.  Maybe it was because he was missing school.... haha.  But he was a great patient.  In order to better manage his pain, we played Clue, wii, and Operation.... all completely nursing-related interventions, of course.  :]  It was a great day, laughing as we chatted and played games.  We even worked on some of his math homework!  He was not excited about that, but I made a deal that we would play Mario Kart after he finished a page of problems.  Kids truly do amaze me... his resilience and optimism was inspiring, and I was grateful for that short amount of time that I was able to spend with him.  He has such lofty ambitions for his future (he wants to be an engineer) and I hope that he finds motivation and support to pursue his dreams!  It reminds me of my younger years... wanting nothing more than to be a doctor.  I've definitely grown since then, and I'm grateful that I've found my calling as a Nurse Midwife. 

It's now Spring Break, and I'm enjoying the time I have to take care of my looong "To Do" list that has been haunting me for the past few weeks!  But of course, I'm taking advantage of this free time to escape to my favorite city -- NYC, of course!  I'll be heading up there this Thursday and staying until Sunday to do some therapeutic shopping :]  Then it's back to the grind... next week is going to be quite busy with school assignments and projects and what not, so I'm trying to stay mentally engaged with that reality.  Having days in the OR is actually helping... I'm returning tomorrow for a very serious and extensive thoracic surgery -- repairing an aortic aneurysm, and also placing femoral shunts.  I'll have more details next week... but I'm looking at multiple hours in the OR tomorrow!  What an opportunity and experience.... I'm quite excited, to say the least!

I'm looking out the window of my room, and it's still bright and sunny outside.. at 5:30pm!  I love DST.  Looking forward to the blooming cherry blossoms this spring.... only a few more days of "winter" -- I survived. haha. Until next time, take care all!