Welcome, SUMMER.

I’m past the halfway point… 3 more weeks at UCH before I officially GRADUATE from Johns Hopkins!  And… I’ve made the executive decision not to return to Baltimore for the ceremony…  Although it would be nice to see everyone again, I feel like I’ve reached a sense of closure over the past month since I left, and I don’t really want to spend the time/money to head back there just to receive my degree.  Instead, I’ve decided to use that money to drive back to California and spend time with family and friends for a couple weeks before I return to Salt Lake for work. It’s been much too long since I’ve had adequate time to spend in California, so this time I’ll finally be able to relax and play at the beach :) Can’t argue with that, right?

But I can’t get ahead of myself… I have to stay focused and on-task while I am here in Denver.  It’s been a rough couple weeks, trying to balance my free-time during the day with sleep… night shifts, as much as I enjoy them, have really taken a toll on my body.  I had gotten into a nice rhythm, but then I had 8 days off (because my preceptor had scheduled herself a week-long break) and so it really messed up my schedule.  I took that time to help Meghan move up to her new home in the mountains… it was a long weekend – packing, driving, unpacking, organizing – but her new house is lovely and in a great little rustic mountain neighborhood near Winter Park.  I’m planning a couple more trips up there to visit before I leave Denver.  After returning to Denver, I moved into Meghan’s grandmother’s home (she has a nice little townhouse in an senior housing complex) and it’s been a delightful treat spending time with Dorothy (when I’m actually awake).  She is a sharp 82-year-old, and she is gone most of the day for lunch dates, card games, and volunteering at one of the local hospitals.  What a little spit-fire too… I swear she has more spunk than me!  She is so sweet, and I appreciate her willingness to let me stay here for a few weeks. 

As for my time in the hospital, nights are rarely quiet on our unit… we are the “high risk” L&D unit, but we also take care of “emergent” issues with pregnant women, so we deal with a wide spectrum of problems… including the middle-of-the-night spontaneous labors that result in precipitate deliveries.  Exciting yes… definitely keeps me on my toes!  I’ve worked another 4 nights (in a row, no less) since my last post, and I feel quite grateful to have seen a wide-variety of patients – it has made me much more comfortable and confident in my role and responsibility, and I feel much more prepared to work on a labor unit later this year.  I’m hoping to have my own patient assignment at some point this week (I work tomorrow night and Thursday night), or at least have a little more independence from my preceptor in managing the patient care.  We’ll see how that works out… I’m a little nervous, but I need to have this experience as a student before I enter the workplace as a licensed RN.  I’ll keep you updated with how things go…

I’m sure you’re curious as to what has happened the past week, and I do have some stories to share!  I’ll try to keep it brief…

Thursday Night

Miriam and I were assigned a 32 y/o patient, having her second child.  In her first delivery experience, she pushed for 2.5 hours and the baby did not come down, so they had to do a C-section.  This time, she was determined to have a delivery, and we have to monitor these patients closely to ensure that they don’t have a uterine rupture (tissues are weaker after they heal because of scar tissue).  She was doing just fine, and baby was descending quite nicely with her contractions… then we finally reached the point for her to start pushing, and because of her epidural, she wasn’t feeling her contractions, and we had to coach her through each push.  Well… baby was a bit impatient.  As the doctors were gowning up for delivery, the little guy popped his head out for a very dramatic entrance!  It caught us all off-guard, and the nurses had to scramble to help the doctors deliver the baby.  Looking back at the whole situation, it was quite funny… in the moment, however, I had never been told what to do in that situation, soooo I was definitely in a bit of shock. But all was well – mom and baby were just fine.  As we monitored her afterwards, however, we noticed her temperature spiking upwards of 103-104 degrees… so we had to start her on an antibiotic drip for chorioamnionitis (an infection).  It’s not at all uncommon for that to happen, so we just continued to assess her regularly.  Our next delivery happened in triage… a precipitate (labor à delivery happens in less than 3 hours) and thankfully mom and baby were happy and healthy, although mom was a bit “mad” at her new baby boy for coming so quickly… she didn’t have time for an epidural, and was not prepared for the pain that she unfortunately had to endure.  But at least it was over quickly! There were a couple more patients in triage for observation, and I overheard that one 22 y/o patient had a BMI of 49… yes, 49.  For those who are not aware, BMI for women should be below 26… above 30 is overweight, and above 35 is considered obese.  49?  That is just a whole new degree of “morbidly obese” – with so many possible/probable complications...  I didn’t have the opportunity to meet with her, but I hope the nurse who did gave her some educational information on the multiple risks associated with her health status – for both her and her baby.  Scary.

Friday Night

Our patient was admitted to our unit because of her uncontrolled diabetes… she loves her carbs, and apparently doesn’t adequately correct with insulin.  So she was put on an insulin drip while under our care, requiring us to check her blood sugar every hour and adjust her insulin accordingly.  She was very sweet, and unfortunately, her labor process was much longer than she had hoped (her last child was delivered 11 years prior, so she was essentially a “primip” – first time NSVD, “normal spontaneous vaginal delivery”).  We were not present for her actual delivery, but we did take care of her throughout the night.  Thankfully having checks every hour kept me busy – that’s the only thing that helps keep me awake!  I need to be walking around, engaged in some sort of task to keep my mind going.  We helped out with two other patients in labor, and unfortunately one of those patients was at 24 weeks (the youngest gestational age that can be delivered and have a chance at survival) and had to have a stat c-section because her membranes ruptured and baby’s heart tones took a turn for the worse.  Last I heard baby was alive and getting stronger, finding the will to live in the NICU.  So tiny, so precious.  What a special little spirit.

Saturday Night

Goodness… Saturday night was rough. It felt like nothing went “right” – each problem we had was made worse, and resulted in a crash c-sec.  Our patient was a 16-year-old from Burma who spoke very little English, and unfortunately neither her husband (yes, husband) nor mother spoke any to help us out.  So we had to use the interpreter phone service (we talk to the interpreter through one headset, then the interpreter communicates to the patient what we have said through another headset… makes a difficult situation even more complicated).  She refused all pain medication, despite repeated “offers” from the doctors and anesthesiologist (which I was not happy with, to say the least).  Her contractions were getting stronger, intensifying her pain dramatically, and she was not dilating quickly at all (hmmm… wonder why).  So, at about 6 cm, she finally consented to an epidural.  Well, we had to talk with her via the translator phone (which I was lucky enough to handle) and try to communicate how she had to sit for the epidural.  She could not comprehend our directions… and on top of it, each contraction she had made her squirm, and another important piece to the placement of the epidural requires that the patient remain completely still (which is near-impossible for a teenage patient who has waited until she is in the later stages of labor to have this procedure done).  The anesthesiologist tried… and tried… and tried… finally realizing that the girl had scoliosis (her spine was not straight) which probably explained why she couldn’t get into proper position.  All in all, it took an hour and a half, and two doses of Fentanyl, to get her relaxed enough to place the epidural (a miracle, if you ask me).  But… of course, nothing could go smoothly… just a few minutes later, her baby’s heart tones dropped to 60 (a VERY bad sign, considering that baby’s HR needs to be between 120-160) and we turned her back and forth to try to improve baby’s condition… nothing was working.  We gave her the “antidote” for fentanyl, thinking that maybe the narcotic depressed baby’s nervous system to cause the drop in heart rate, and that med unfortunately did not cause any change in baby’s status.  So… we rushed her back to the OR for a crash c-sec.  I could see the terror in her eyes, so I made it my responsibility to stay with her and hold her hand (because she was conscious during the surgery) and offer some reassurances that she would be okay.  Baby came out screaming just a mere 5 minutes after we rolled into the OR, getting APGAR scores of 8 and 9 (out of 10) – indicating that he was a very healthy boy.  After the craziness of her labor/delivery, we spent time in the PACU while she recovered, and she and her mother were able to bond with the newest member of their family.  It was quite a special time, and I was grateful for the opportunity I had to offer her comfort in what would be a very scary experience for an individual who was raised in a culture where babies are not normally delivered under such circumstances.  I knew that I was there for her, and even though we were not able to communicate with words, the simple gestures of a comforting touch and a reassuring smile conveyed more than any words ever could have.  Such a special moment… especially when I was able to hand her son to her to hold for the first time… have I mentioned recently how much I LOVE my job?  Yes, there may be experiences and outcomes less than ideal, but the most important aspect of my position as nurse for these patients is to offer them support and care during these stressful times.  On that same night, another patient delivered a baby with multiple congenital anomalies, and the baby was given only a few hours to live.  I know that many of my experiences will not be “picture perfect” but I am grateful to be able to offer comfort to these families in any way that they may need.  It is an awesome responsibility, and I know that the Lord will prepare me to handle these delicate situations, as difficult as they may be. 

Sunday Night

Unfortunately, we had a VERY quiet night… Miriam and I took triage, but we only had a few patients check in, nothing too serious.  Around 3ish, I started feeling quite nauseated and weak, and as much as I tried to stay active and engaged in my work, I was not feeling well enough to stick it out until 6:30… so I left a few hours early.  Apparently my body was trying to tell me something – over the past couple days, I have slept almost 24 hours!!  So… hopefully I’ll be recharged and ready for tomorrow night when I return… two more shifts this week, then it’s back to Salt Lake for the 4^th!  I can’t wait… white-water rafting on Saturday with the fam, it’s going to be GREAT fun.  SO with all that said, I’ll leave you until next week…   have a great holiday everyone!!

Life at 5,280 feet...

It's Saturday morning, and I'm awake and appreciating the refreshing air a mile above sea-level.  What a difference altitude can make!  Okay... maybe not just the altitude... the plentiful evergreen pines and the staggering rocky mountains might also play a role in the beauty of this environment.  I will say, even though I am sleeping on a couch, I feel as though I am getting better sleep here than I ever did in Baltimore!  I'm sure the fact that I work 12-hour night shifts plays a small part... but in all honesty, I finally feel like I am in my element -- I have the confidence to go out and flaunt my talents and unique qualities that make me who I am.  It's quite empowering, and I am very appreciative for this experience as I transition from the title of "Student Nurse" to "REGISTERED Nurse."  Only a few more months and I will be (HOPEFULLY) working to establish myself as a nurse on a hospital unit in Salt Lake City.  As of right now... jobs are pretty hard to find, especially for us "New Grads," but I have faith that something will pan out -- the Lord has blessed and guided me to this point, so why would He stop now?  Besides... I found out that my preceptor worked on the postpartum unit at University Hospital (yes, University of Utah) before moving to Denver, and she has a great relationship with the nurse manager that I'm hoping to work for this fall... coincidence?  I THINK NOT.  Someone is definitely looking out for me....
Although I've related stories of my first few nights on shift to a few of the handful of people that actually read this blog, I know there are still some who have not had the pleasure of hearing/reading about the excitement on the High Risk L&D Unit ("Women's Care Center") at the University of Colorado Hospital.  SO, without further adieu....

Night 1
My first night on shift was a bit of an adjustment, to say the least... not only did I have to develop a working relationship with my preceptor and the other members of the night shift, but I had to do it while trying to survive my first 12-hr NIGHT shift in a hospital.  I won't downplay it... it was difficult.  I felt myself nodding off a few times between the hours of 2-4 am... thankfully L&D is busy, no matter the time of day; it's actually surprisingly more busy at night than during the day -- my theory is that women are producing hormones at night that cause their cervix to relax, making the contractions more effective at dilating/effacing the cervix.  But... that's just my theory.  Either way, I was present for 2 deliveries that night -- no complications or issues, which was not necessarily what I had expected on the "High Risk" unit.  But hey, there is nothing wrong with that!  I am all about healthy moms & healthy babies.  And I was grateful to see the team work seamlessly to help bring these newborns into the world. 

Night 2
My second night on shift was a bit more of a "reality check" -- not every woman who delivers on this unit is going to be the ideal "mother" candidate, and it can be somewhat disheartening to see infants born into home environments and situations that will not provide adequate love and support... but this is where faith comes in.  The Lord will watch out for His children... even the 6th child to a 41-year-old drug addict/prostitute who has had 14+ abortions... thankfully she had her tubes tied, the one responsible thing she did in this situation.  It was quite the contrast to my other patient, a 21-year-old wife and mother of 3 children (ages 1, 2, and 3 -- all planned pregnancies) with the 4th born while she was under my care.  Her husband was present, and they were both very engaged in the process... my preceptor hinted that this is something I should expect to see when I start working in Utah.  Made me laugh :]  But it was a warm and happy reception, with my patient knowing her role and responsibility as a new mom... while my other patient turned away from her baby girl and did not uphold her end of the "contract" that she made when she decided to continue this pregnancy.  As frustrating as it is, we as nurses are there to comfort and educate, and advocate for our patients... we do our best to engage our patients in the care of their child, but it's not up to us.  Maybe CSS will get involved and help this infant into more suitable home environment... all I can do is trust in the Lord's reasoning.

Night 3
In honor of my 26th birthday, I celebrated the BIRTH days of 3 new infants at the hospital.  It was a busy night, to say the least... my preceptor (her name is Miriam, FYI) decided to take on the responsibility of "Triage Nurse" and as I am her shadow, I followed her throughout the evening.  Triage is basically the ER for any pregnant woman over 20 weeks gestation... so we see anything and everything, from uncontrolled glucose in diabetic patients, to labor checks, to MVA issues (car accidents), and so on.  Our first patient was EXTREMELY uncomfortable -- her contractions were incredibly intense, and we checked her progress and discovered that the baby was breech (meaning that the feet are down instead of the head, not an ideal delivery presentation) and therefore we needed to roll her back to the OR for a stat C-section.  My first (and only) c/s to date, and everything went just fine.  Then it was back to the triage rooms for more patient assessments.  After a while, a patient on the floor went into active labor, so I accompanied the nurses while she was pushing... for a very long THREE HOURS.  Yes, 3.  When the little boy finally made his debut, crying loudly for all to hear, his little head was definitely misshapen and we had to reassure the first-time dad that the caput would disappear. But all was well, so it was back to triage... we had a busier night than normal, and it ended with our last patient -- a 14-year-old in active labor.  She had her mother and brother with her, and her mother was offering great support, keeping her focused and engaged in the process.  I was quite impressed, and grateful -- teenagers require a totally different approach in managing labor, and I know it was best for her mom to check her attitude.  I left before she delivered, but when I returned that evening she was surrounded by about 10 members of immediate/extended family... and she was breastfeeding... it was slightly awkward, but at least she has ample support during this process...? 

Night 4
This night was definitely slower than normal, so I spent time studying for my upcoming boards (aka NCLEX) that I will be taking later in August.  I did have one laboring patient -- the wife of a soldier being deployed to Afghanistan next week... he was there, and was a great support for his wife and their 1st (and then 2nd) son.  Bittersweet, to say the least....

Night 5
My third night in a row proved to be no less exciting than the rest!  My first laboring patient was admitted to the hospital after going into pre-term labor up in her mountain home... she had planned to deliver au naturale at their local hospital, but preterm babies do not do well at higher altitudes, so she had to come down into the city to our unit to deliver.  And she did go forward with her plans to deliver sans medicines.... my first experience assisting a patient through the active labor process without any pain relief.  It was... eye-opening.  I'll leave out the details, but around 8 cm she was asking for an epidural, but at that point she was dilating too fast to take any sort of break.  And after her baby girl was delivered, she was in complete awe of how "perfect" she was, and all thought of the pain she endured to bring her into the world was conveniently wiped from her memory.  Despite the obvious, the delivery couldn't have gone more smoothly.  In obvious contrast to this "ideal" scenario, later in the shift, we were about to walk to another room to start an IV (YES -- I am starting IVs and doing blood draws, quite successfully I might add!) but before we were able to leave the nurse's station, we heard a woman coming off the elevator (obviously in later-stages of labor) and saw just as she slumped off the wheelchair in front of the check-in desk.  Yes, she delivered a healthy baby girl on the floor of the unit's entry way.  The dad was standing above us as we rushed around mumbling "I didn't drive fast enough..."  haha.  But in the end, mom and baby were happy and healthy, and dad brought his other two children (who were still half-asleep) in to meet their new little sister.  That will be quite the story to tell once they get home!  After making sure that she was taken care of, we went down to (finally) start that IV... for a diabetic patient who was being induced due to her inability to manage her glucose levels while at home.  Quite frustrating, especially when we walked in and were met with the overwhelming aroma of cigarette smoke.  Lifestyle behaviors are some of the most critical factors in healthy living... and the hardest to treat/change in the limited amount of time that we interact with these individuals.  We make our best efforts... but unfortunately, some people are unwilling to consider alternatives.  And even worse is when we are affronted with cutting remarks while we are trying to help these people... all we can do is smile and do our job, and leave them be.  That is definitely one aspect of this job that I have had difficulty adjusting to... trying to offer my knowledge and service to people who are convinced that we are being rude, inconsiderate and condescending.  We can't please everyone I guess!

So. That's my "little" wrap-up, for now... I've had a few days off, and I don't go back to work until next Thursday so Meghan and I are heading up to Winter Park (where she will be moving to in a couple weeks for her new job) to escape and enjoy time in the mountains for a few days!  I'm excited -- and I just found out today that the resort she will be working at has 30 horses for guests to ride... and she has a fairly good feeling that we can "borrow" a couple horses for a day :]  I'm SO excited.  For that, for bike-riding through the little mountain town, for s'mores and a big BBQ, and for some SUN.  Oh how I absolutely LOVE summer, and especially summer days spent OUTDOORS enjoying and appreciating the nature we are so fortunate to have right outside our doors :]  How truly blessed we are that Someone loved us so much to give us this Earth....

peace.love.baltimore

I finally have a moment to catch my breath... smell the roses... appreciate the fact that the sun is shinning brightly throughout these long spring/summer days.  And I feel like I can actually BREATHE... not just because the air a mile above sea level is a bit cleaner, but also because -- unbelievably -- I'm DONE.  Well, almost.... I've finished my time on campus in Baltimore, and now I am currently in Denver, Colorado for the final 7 weeks of my 13.5-month program at JHUSON.  Don't worry, I can't believe it.  I've woken up the past few days needing a confirmation that the past year wasn't a dream.  The more I think back to my time in Baltimore, the more I start to wonder if I imagined it all... how could that have actually happened?  How was I able to endure that stress and pressure for that long??  I still can't quite figure it out... but it doesn't matter, because I did it.  WAHOOOO!  I know, I know... I'm not quite done.  But this is the "FUN" part -- I am working on the high-risk Labor & Delivery unit at Univ of Colorado Hospital for the next 7 weeks... ALL NIGHT SHIFTS.  Not quite sure what to expect... but thankfully I know I'll be busy.  I don't think I would be able to survive otherwise!  My first night is tonight... I'll be sure to update you once I've recovered in the next few days!  But before I begin this new chapter of my life's story, let me wrap up the adventures of my last month in Baltimore....


So.  I last wrote while I was on a plane heading back to the east coast after a lovely trip (and much-needed break) to Utah and California.  Salt Lake was my first stop, only staying a couple nights for job interviews at University Hospital and Intermountain Health.  Neither has open positions for New Graduate nurses, but they encouraged me to check back in July (closer to my graduation date) for any updates.  So I'm REALLY keeping my fingers crossed.  I'll have to get some sort of part-time job to cover all my expenses in the mean time.... I have faith that it will all work out, in one way or another.  Then it was on to California for a "surprise" visit for Mother's Day!  I was so grateful to be able to spend time with family and friends... definitely gave me a re-charge so that I could have the energy to survive my final weeks of school.  But of course, time flies when you're having fun.... and before I knew it, I was back on the plane to Baltimore.

The past few weeks are somewhat of a blur -- I know I lived through them, but I don't remember much of the specifics... I was running on pure adrenaline from one day to the next, and I knew that if I allowed myself to slow down at all, I would lose the momentum I had established.  Looking back, I don't know if that was the best plan... I was constantly focused on the next item on my "To Do List" and never gave myself time to break and collect my thoughts... preventing myself from being present and enjoying any given moment.  I did what I felt needed to be done to get through school, but I forgot to enjoy the life that I had created for myself on the east coast as it was wrapping up.  So now, here I sit, reflecting back on days gone by... reminiscing with some regret on missed opportunities.  But it is what it is, so now I'm taking that sentiment to make the most of my time here in Denver, hanging out with Meghan -- one of my closest friends, and the person I have to thank for this opportunity here at UCH (she's graciously welcomed me into her apartment to crash on her couch for the next 7 weeks).  I wasn't planning on returning to Baltimore for graduation at the end of July, mainly because of expenses relating to the travel, but I realize that I need to bring some closure to my time there so it would be best for me to fly back.  Besides, I get to walk across a stage and actually get a "diploma" -- something the PhySci Dept at UCLA didn't believe an important rite of passage for college graduates!  Unbelievable, right?  haha.

Without going into much detail about my classes -- which, I must say, were all surprisingly engaging and interesting -- I'll just say that I feel like I learned a great deal that I can take with me into my future role and responsibility as a nurse.  From Public Health, which helped me appreciate how much social/environmental factors can affect a person's health status, to Transitions, which taught me very practical information about hospital functioning and how the nurse fits into the equation, to the very specific "Fetal Surveillance" (which probably doesn't need much explanation).  As I look back on these past 7 weeks, I realize that I learned more about myself and my own strengths and areas needing improvement than I have in the past 3 semesters combined.  Maybe it was my state of mind... I channeled all my attention and energy to handle the most pertinent issues, and that wasn't much... leaving room for much frustration.  But I will say, I am grateful -- I want to offer the best service and care for my patients, and in order to do that, I need to address my own weaknesses.  So that is what I plan to focus on during these next 7 weeks... I'm just hoping for a preceptor (my direct nurse supervisor) who will help me work on this, without being dictatorial or condescending.  I have high hopes, but I will find out tonight.....

One other thing I want to bring up is my recent Public Health trip to the US Virgin Island of St. Croix... I spent 9 days on the island with my clinical group for our final rotation at Hopkins.  It was a great experience, and as I mentioned earlier, gave me a better understanding for how much lifestyle/living conditions can affect an individual's health.  While I sat at the bedside of a 90-year-old woman who was blind and unable to walk through her home without assistance (forcing her to use a pail for her toilet) and listened to her relate stories of her life on the island of Antigua and sing songs of praise to Jesus, I had a flashback to my time spent in Africa.  Such humble living conditions and evidence of disparity, yet she could only express her gratitude for a merciful God that had given her so much, and most importantly, a loving and supportive family (with one person stopping in to check on her each day).  Such a sweet experience.  And that wasn't the only one... but so that I don't take another hour of your time, I'll limit myself to sharing photos to give a brief recap of our time on the island:

And then it was back to Baltimore, for a VERY intense week of school, catching up on the classes we missed while we were away, and turning around to study/prepare for our finals -- which included 3 exams, 1 presentation, 1 paper, and a 45-page project.  Needless to say, I didn't have much free time.... and before I knew it, I was on a plane to Salt Lake.  I felt as though I had blinked and the week was over -- my last week as an East Coast resident.  Hard to believe that it could ever come to an end.... but, it did.  The last few days at school we shared with the incoming class of Accelerated students.... watched them as they put on their lab coats and walked into the skills labs... all discussing their Health Assessment lectures in anxious anticipation for application on their patients during their clinical... that glow of excitement -- it was quite familiar, and even though I may be burnt out from the overwhelming stress of the past year, I know that will return just in time for me to begin my "calling" as RN. And with that said, I'll leave you all... need to get things my mind straight and ready for tonight!!  Wish me luck.... =]