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.... =]

back to reality.

I’m aboard an airplane flying over the Rocky Mountains, returning to Baltimore for the final weeks of my nursing school classes… if only I were still as motivated as I had been at the beginning of this year!  I have to admit, my body is exhausted and my brain is fried.  I am BURNT OUT.   As much as I love nursing school, I’ve been at it, full-speed ahead, for 11 months now… with no time to rest and catch my breath.  The past 4 months have been the most arduous by far, because we were in 14-straight weeks of Adult and Pediatric health, and then we moved right on to Public Health, with no time in between… at least Public Health, and the other 2 courses I am presently taking, are interesting and deliver practical information that will benefit me as I transition into my role as a full-time nurse. 

Public Health focuses on the importance of disease prevention and health promotion in the community.  We have spent most of our time analyzing the Baltimore community, which is beneficial for those who are staying local…  but the statistics are not really representative of the communities that I will most likely be dealing with in Salt Lake. However, we are discussing many (commonly PREVENTABLE) diseases that plague this nation including hypertension (HTN), obesity, and diabetes (DM) that are not relegated to any one particular population or environment.  I have taken great interest in the obesity epidemic as it relates to public health, because of the relative “ease” by which it can be prevented/treated.  Poor diet and inactivity are directly related to an increased rate of obesity, and the comorbidities that subsequently follow.  The most unfortunate statistic is the ever-increasing rate of Type 2 DM diagnosis in children.  I know I’ve mentioned this before, but I have to mention it again – the younger generation of our country is the first that has a shorter life expectancy than that of their parents.  In other words, my generation will be overwhelmed with the aging “baby boomers” that are expected to live to their 80s-90s, and we will also be treating the chronically ill generation below us that may only live to their 60s-70s.  This is what we are being trained for in school – both geriatric and bariatric nurses are going to be in high demand in the coming years… They’ve already established a specialty geriatric ER in Washington DC.  SO.  What can we do to turn this epidemic around?  Many people have thrown up their hands and given up… it seems so overwhelming, that our efforts will not be enough.  But with that attitude, there simply is no hope for the majority of the children in this country to live a long and healthy life.   Public Health nursing is a much different aspect of patient care – it encompasses community health surveillance, education, intervention, and policy advocacy.  We are asked to write a paper about an issue that is currently under investigation/review for future policy change, and my focus is on vending machines and snack food available to children in schools.  Cafeterias are one thing, as they are monitored and controlled by adult staff (who don’t always adhere to the guidelines unfortunately) but with vending machines, kids are able to pick and choose whatever candy, chips, or soda they want, with unlimited availability.  California is one of the first states to ban the sale of sodas in schools, which I think is commendable.  I have printed out information regarding this policy and intend to review it this weekend for my paper.  There are many states that have enacted various policies targeting this at-risk pediatric population, but more needs to be done.  Our Public Health clinical group was able to travel down to DC this week to watch a Senate hearing, and we also met with Congresswoman Christian-Christensen, the Representative for the US Virgin Islands (where we will be traveling in a couple weeks for our clinical rotation) and I learned about health policy, and more importantly, how my voice can actually make a difference.  Our instructor gave us a quote that really drives this home: 

“If you are neutral in situations of injustice, you have chosen the side of the oppressor.  If an elephant has its foot on the tail of a mouse and you way that you are neutral, the mouse will not appreciate your neutrality.” – Bishop Desmond Tutu

I scanned the State of Utah’s government website, and my Congressman Jim Matheson doesn’t have anything on his agenda that addresses the issue of childhood obesity.  Utah’s obesity rates are extremely high (above 25% I believe) especially considering that only 10 years ago, it was below 10%.  What can it be attributed to?  Yes, there has definitely been an increase in fat and sugar consumption, but the surprising fact is that the weight gain in kids is more reflective of their sedentary lifestyles.  80-90% of younger school-age children spend a majority of their free time indoors, which is frightening.  Whether that is because of TV/video games or unsafe neighborhoods, the truth remains.  This imbalance between caloric intake and energy expenditure is the root cause of obesity, which is responsible for most of the chronic illnesses that are the leading causes of death in our country (heart disease and stroke).  More attention needs to be paid to this issue, and I look forward to the opportunity that I will have to educate new parents on the importance of including activity in their daily schedules, and making a conscious effort to eat a more balanced diet.

Well, now that I’ve taken up a majority of this blog entry discussing my Public Health interests, I’ll leave my overview of my “Special Topics” course to my next entry (which looks at the nurse’s role in fetal surveillane).  But, I do want to mention some exciting news – I have FINALLY learned of my placement for my Transitions Practicum (my final clinical rotation before I graduate).  I have been blessed with the opportunity to work in Denver, Colorado for 7 weeks (June 7-July 22 for those who are curious) and I have been assigned to the Birthing Center at University of Colorado Hospital.  It is the absolute perfect placement for me!  I will be assigned a nurse preceptor (supervisor) for the 7 weeks, and I will basically work alongside her during her scheduled shifts, so 36+ hours each week.  This experience will undoubtedly help ease me into the role of RN, with ample opportunity to learn the responsibilities I will have while caring for laboring/postpartum mothers.  I cannot wait!!  I will have much to report once I move there…. In only a few short weeks.  Yes, that does mean that my time in Baltimore is quickly coming to an end.  I fly out on June 4, so I have a lot of packing and prep work to do before then, in addition to taking care of the endless amounts of assignments that our instructors have loaded up at the end of the semester.  Such fun.  And… on top o it… I’m leaving for St. Croix, so I have to make sure that I am on top of my work before I leave so that I’m not overwhelmed that last week that I have once I return.  Wow.  I’m starting to get a little anxious about all this…. SOOOO I think I’m going to change topics! Haha.

A couple fun things have happened in the past few weeks (aside from this weekend’s trip to Utah/California, which I will leave for my next entry to discuss).  I was able to attend a service at the National Cathedral in Washington DC that celebrated the International Year of the Nurse (2010 marks 100 years from the death of Florence Nightingale).  It was a special event, with nurses from all over the Northeast region, as well as from other countries, all gathering to honor and pay tribute to Flo (as we call her at Hopkins) and the nurses around the world who carry on her legacy.  It was special, and I realized that I am now a part of this association of individuals who are committed to the service of others.  Quite powerful, and I feel so honored to be a part of this global society.

Before I end this entry (which I recognize is already quite lengthy, and I apologize for taking up so much of your time!) I just want to mention an event that I participated in last weekend down in DC.  Every May, there is a 5K that is held in the gorgeously green parkland outside the city, and it’s called “Run Amuck.”  My friends were talking about this activity, and if any of you know me, you know that I despise running.  Especially running for “fun.”  BUT… this was different – we would be running the 3.1 miles on a park trail, up and down hills, through mud and over obstacles.  It sounded like such a blast, and I couldn’t pass up the opportunity!  So last weekend we got our oldest shoes out and made our way out to Rockville, MD for the adventure.  I had every intention of training for this race, but time got away from me… So I ended up running it “cold” – and I was quite impressed with my time!  If I didn’t wait for some of the people in my group, I think I could have made it under 35 minutes, but my time was just over 40 minutes.  Not too shabby… but more than anything, it was SUCH a fun time and I was so glad that I decided to participate!  I’ll share a few photos from the day… then it’s time to enjoy the rest of this flight before I’m back in Baltimore.  Countdown beginsL 12 more days until I leave for St. Croix, and 24 days until I move out of Baltimore to Denver.  My time on the east coast is quickly coming to an end…..

just another day in the OR...

Johns Hopkins Hospital is known to many as "the best hospital in the world."  For a while now, I've wondered what part of the hospital these people were referring to... but my questions were finally answered at clinical last Friday.  I've come to learn that the pediatric population we serve is far from normal -- we see the rarest of all diseases and syndromes on our floor, simply because no other hospital knows what to do with these children.  Hopkins boasts some of the best specialists in the world, those who are able to diagnose and treat this vast array of "unknown" illnesses.  I have to constantly remind myself that the patient population we see and care for on a daily basis are not typical of most hospitals... but it has definitely prepared me well for how to handle the unexpected.  So when I learned that my young patient on Friday had been flown in from Saudi Arabia a few days earlier for skull reconstruction surgery after a car accident left many of her facial bones crushed (car vs camel... did not bode well for either), I was eager and ready to take care of her prior to her scheduled procedure.  She was easily my most complicated patient to date, and there was a lot that I had to be aware of and monitor.  I know she couldn't understand what I was saying (either because of her mental status or the language barrier) but I offered her words of comfort as I did her pre-op assessment.  Her brother arrived shortly thereafter (he is the only family she has here), and I left them alone so that he could read through prayers for her.  The time finally came, and we transported her down to the general pediatric OR.  Her brother never left her side, reciting prayers and words of comfort in their Arabic language before she was wheeled into the sterile operating room.  As I walked into the OR with my patient, I looked back to the brother, and realized that this was his sister that was now in our hands.  It's easy sometimes to forget the immensity of our responsibilities as health care providers, and that moment made it very clear to me.  Without going into graphic details of the 7-hour surgery, the doctors were able to re-assemble the shattered pieces of her temporal bone and reconstruct the crushed frontal sinus -- and I was able to witness the entire procedure from just a few feet away.  It was incredible.  Although I kept reminding myself that it was my patient underneath the sterile drapes, I was captivated by the pure "magic" that is surgery.  It brought me back to my days in Advanced Anatomy... I had forgotten how truly incredible the human body is, and how fascinating the complex inner-workings and processes are that keep us alive and running.  Aside from a brief 30-minute break to rest my legs, I observed the entire surgery, and it was quite an amazing experience.  And what's even better - it was a success!  She was transferred to the PICU after the operation, so I wasn't able to follow her, but the doctors were hopeful that she would recover.  To what level, we aren't quite sure.  I believe she has a few more surgeries scheduled before she eventually returns to her native Saudi Arabia, but I do hope that she pulls through. 

Even though I feel such a strong connection and fascination with the realm of surgery, I realized that I could NEVER be an OR nurse.  Standing next to the surgeon, handing him tools for multiple hours... the atmosphere was "relaxed" (everyone chats during the surgery, listening to music as they work) but the nurses don't ever meet the patient or the family, and they have no connection to the case they are working.  It's just another chart and another surgery before the end of shift.  I need patient interaction -- even if I don't see the end-result of my efforts caring for my patients, it's the relationships nurses can develop and the comfort we have the opportunity to bring while we work with these individuals.  It truly is a calling, and I am so grateful for this opportunity I have been given.  And I'm getting closer... 10 months down, 3 to go!  Third semester will be complete by the end of the week (exams today and tomorrow, final peds clinical day on Friday) and then I begin my FINAL SEMESTER next Monday!  We take our "Transitions to Clinical Practice" course, Public Health, and Special Topics -- which I found out will be "Fetal Surveillance" on Fridays!  So perfect.  I can't wait!  But first... I have to make it through this week.  Meaning I need to get back to studying.... until next time, take care all!

maybe that "global warming" idea isn't a hoax after all....

It's 8:30 am as I start into this entry... I just took a leisurely stroll to the Ro-Fo (aka Royal Farms, our local 7-11) and it's already 75 degrees outside!  Whaaaaaat the heck.  Apparently we missed spring and went straight into summer!  It's been over 90 degrees the past 2 days, record highs for this time of year on the east coast.  My goodness... we're just breaking records left and right!  I really don't mind this weather though... just wasn't ready for it!  Neither were my pasty white legs... haha.  It will take some time before I'm brave enough to bear them in public.  Just wish I had somewhere to lay out!  Well... I should say that I wish I had TIME to lay out... our current schedule doesn't really allow for much free time, although I do have a day off today (AMAZING) so a friend and I are going to head out to Towson (it's a few miles north of here) to get out of the city for the afternoon.  I'm looking forward to that... any time out of the city allows me to BREATHE.  As much as I love school and this learning process, I think I'm definitely burning out... maybe it's Baltimore, but I feel like I'm falling into a black hole and I'm clawing at the edge trying to do anything to keep from being sucked in.  Okay, so that may be a little exaggerated, but you get the point.  I know that as soon as I'm out of this environment I will miss it, so I'm trying to stay positive and make the most out of the 57 days that I have left until I'm out of Baltimore... and I will say that I'm pleased with my efforts!  The past couple weeks have been quite great actually, and my goal to stay PRESENT and appreciate these precious, fleeting moments of my life has really been a great motivation. 

So.  March came and went, another month of 2010 over.  Just like that.  I feel like I blinked and it was already April.  Probably because the past few weeks of school have been a marathon -- I've really had to pace myself in order to get through the mess of exams, projects, presentations, and other miscellaneous assignments.  But next week is the last week of this semester!  Three out of four semesters, nearly complete.  I have 2 more exams and one more presentation to wrap up this semester, and then it's on to my final 14 weeks!  My classes will include Public Health, and my clinical experience in St. Croix will tie in with that course, and a "special topics" class (which I have yet to find out the actual topic... could be fetal surveillance or global health).  My "Transitions" class also begins, which corresponds to my final clinical experience which I will be completing in Denver, Colorado.  Have I mentioned that?  Hmm... I don't know if I have or not!  Well, briefly -- my final 7 weeks of the program (June 6-July 22) I will be living in Denver with one of my closest friends from UCLA, working at a hospital under the supervision of a nurse "preceptor."  Basically, I shadow her on all her weekly shifts (I could even work nights, if that's her shift!) and over the course of the 7 weeks, I will slowly "transition" to complete autonomy as a nurse!  It gives us an opportunity to have 1-on-1 guidance to prepare us for the demands of our future role and responsibilities as RNs.  It will be a great learning experience, and I'm really looking forward to it!  I haven't found out yet what unit I'll be working on, but I will be sure to share that information when I hear from the course coordinator (hopefully soon... it's not that far away....)  So that's the final wrap-up of this whirlwind 13.5-month program.  I've already finished 10 months.... the end is in sight... then I can work and get clinical experience for a year and a half in Utah before applying to their Nurse Midwife/Women's Health Nurse Practitioner program!  I recently learned that I can get a dual-master's degree, becoming both a midwife AND a WHNP, which is a DNP program -- I'll be a "Dr." after all!  That option will provide ENDLESS opportunities for me, and it's only 3 years... if I didn't think that getting experience was so critical to my success once I graduate from that program, I would apply to start next year... but I'm trying to take it slow.  No need to rush!  But I am EXTREMELY excited for that next step in my education... I've already been in contact with the program director, and I'll meet with her once I've moved back to Salt Lake, to make sure that I will be adequately prepared and that my application will be well-qualified during the review process.  But... the first hurdle I have to overcome is finding a JOB.  I plan to return to Utah in a few weeks to meet with nurse recruiters about future job opportunities for new grad RNs (it's slim-pickings these days for new grads, unfortunately, due to the state of our economy...)  Actually, let me address this problem really fast.  Most people are surprised to hear that there are very limited jobs open for new graduates, because people hear about "nursing shortages" -- SO. to clarify: there IS a nursing shortage, but because of the economy, many retired/part-time nurses are applying for full-time positions, leaving us new grad RNs out of the application pool because hospitals would rather not have to orient/train us (which is expensive) when they can hire experienced nurses.  Frustrating.  Our instructors/professors reassure us that this will change... eventually... as soon as the economy shifts, basically.  But I'm exhausting my resources, and hopefully meeting with these nurse recruiters next month will translate into something.... aka a position on their L&D unit.  We'll just have to wait and see.  I wish the only things I had to worry/stress about were related to completing assignments or studying for exams, but I have to try to coordinate my life in Utah while I'm stuck 2,000 miles from where I need to be managing it.  Just a tad bit complicated.  It's all coming together though... I've sought out ample support from the Lord on this one, and I know that He's helping to guide me through this process. 

In order to find balance amidst this mess of uncertainty, I've been trying to find outlets and ways to spend my time that allow me to appreciate the beauty of my surroundings on the east coast.  This past weekend I was able to travel up to Pennsylvania to visit one of my mom's friends, Rikki, who lives in the countryside near Lancaster (Amish country).  I was SO grateful to have a car and make the 1.5 hour drive north through the rolling hills of the green Pennsylvania farmland, and remind myself of what the east coast truly looks like.  I spent Saturday and Sunday morning with Rikki at her home, a peaceful and serene slice of heaven for me in contrast to my life in the city of Baltimore.  I was able to help her with the menagerie of animals she and her husband care for on their property, including 15 peacocks, 5 deer, 3 horses, 2 cats, and a charming dog named Betty Bird.  It was exactly what I needed to recharge for these upcoming 2 months that I have left in this city.  Aside from that escape, I was able to stay at my friend Rachael's house in Reisterstown (a suburb of Baltimore) last week, and participated in their seder dinner for Passover.  Quite a neat experience, and I very much appreciated her parents and their hospitality as they welcomed me into their home and their service (which I was asked to participate in, so interesting!)  I also made a trip down to DC with another friend, Dara, to experience the beauty of the Cherry Blossom Festival -- I'll be sure to post pictures below.

As much as I have loved the experience of living on the east coast, I'm quite ready to return to life out west.  I'll definitely miss the weekend trips to New York though.... I think I need to squeeze in one more city adventure before I leave :]  Well, the sun is out and shining brilliantly, I think that means I should take advantage and add some color back to my cheeks!  Maybe do some "hot" yoga outside today... mmm that would be lovely.  Wouldn't even need a heater! haha. Take care all!  Namaste [:

 

[pretty peacock]

[Clydesdales - the true "gentle giants"]

[Julie the Deer loved my camera]

[my new favorite flower: daffodil]

[Amish horse & buggy]

[cherry blossoms]

[cherry blossoms with the Jefferson Memorial in the background]

side note: I think I finally figured out what an "apricot tree" might look like -- don't those cherry blossoms look like little tufts of popcorn?  ;)

Spring Awakening

It's early Saturday morning, and I'm sitting in my little loft, waiting for the sun to come streaming in through my windows and for my new little birdie friends to come visit me on my windowsill.  I almost feel like Cinderella... now if only I could get them to do my laundry... haha.  It promises to be another beautiful day here in Baltimore, and I am grateful for the change in season.  I used to think that summer was my favorite time of year, but after this winter and the recent shift in weather, I realize how much I LOVE spring.  Not just because it allows me to walk to school in the morning without the need for 5 layers of clothing, but rather for what it symbolizes: REBIRTH.  I've enjoyed walking through the city streets, admiring the budding and blossoming flowers, rejuvenated after a long winter hibernation.  Despite the 80+ inches of snow we had this winter, these marvelous works of nature are able to "come back to life" and share their beauty for us all to appreciate.  I know I personally appreciate the return of the sun, and the warmth that it brings with it, but I feel like I've reawakened - to life, to possibilities, to the wonder of this Earth, and to our individual significance as a member of humanity and one of God's children.  Easter is next weekend, and when you are able to look past the chocolate bunnies and see what the day really represents, it is humbling.  The most important and significant "rebirth" -- the true symbol of this time of year.  I feel so blessed... for many more things than I have time to share here.  But I am grateful for the knowledge that I have, the opportunities and experiences I have been given, and for the people that give my life meaning.

SO.  One thing that I struggle with is being present, in the moment, and recognizing and appreciating that which is right in front of me.  My mind likes to race forward, planning and preparing for the coming weeks and months, and before I know it, another day has passed me by.  Here I am, end of March... I only have one more full month in Baltimore, and then I'm OUT!  April will definitely be a busy one, so I know that it will be over in the blink of an eye... I have much to look forward to, but I'll get there soon enough.  So let me focus on what has happened the past couple weeks since I last posted...

I had the opportunity to return to the OR for another surgery... it was an incredible experience.  Watching the surgeons repair a thoracoabdominal aortic aneurysm was... awesome.  Not sure how else to describe it!  And let me just mention that the guy they were operating on was 6'5" and 450 pounds.  No joke.  Unfortunately, the surgery lasted much longer than I could stay for (I had tutoring with Ivan) but I do hope that he is doing well and making a full recovery to return home to his family and then to work as a middle school principal.  I will say... that is one thing I appreciate about bedside nursing -- the opportunity to develop a connection with the person behind the diagnosis.  It's not enough for me to understand the diagnosis and treatment plan; I need to know what events brought them to the hospital, and other factors that may be helpful pieces of information to improve the course of their care. 

After my second day in the OR, I was able to escape Charm City to enjoy a few days of my Spring Break in the Big Apple.  And I couldn't have asked for better weather!  The first day of spring in the city was well over 70 degrees, and I was thrilled.  New York can be one of the most miserable places to be when it's cold and windy... I was ecstatic when I was able to walk down Fifth Avenue with my sunglasses on :]  haha.  It's the little things that really do it for me!  The other highlights of my weekend included spending a sunny afternoon at the park relaxing on blankets with some new friends, , exploring the hidden beauty of Battery Park along the banks of the Hudson River, wandering through the halls of the impressive New York Public Library, and spending quality time with one of my favorites as we did yoga underneath a willow tree in Central Park.  Not a typical weekend in the city, by any means, but one of the most enjoyable and memorable ones to date. 

 

 

 

But of course, good times must always come to an end... and usually much quicker than you hope.  So Sunday night I returned to Baltimore, just in time to get a few hours of sleep before a painfully long and busy week of school.  Projects... assignments... exams... everything is piling on as we near the end of this semester -- only 3 more weeks to go!  At least I'm having an enjoyable time in clinical -- much less intense and stressful than Adult Med-Surg.  Thursday of this week, we spent the day at a catholic elementary school with the school nurse, and did some health education with a class of second graders.  Topic of discussion:  HEALTHY SNACKING!  Not just healthy eating... but what to reach for (or ask for) when they are hungry between meals.  I hope our activities at least got them to recognize that fruits and vegetables are better than chips and candy.  Gahhh -- don't even get me started on the obesity crisis that we are currently experiencing in the US!  That is definitely one of my interests when it comes to health promotion and education... here's a video that can better illustrate the nature of this problem that we must acknowledge and deal with:



 ... and here are some facts that I'll add on to that message:

• In 1990, ten states had a prevalence of obesity less than 10%, and no states had a prevalence greater than 15%.  By 1999, NO state had prevalence less than 10%, eighteen had prevalence between 20-24%, and no state had prevalence greater than 25%.  In 2008, only ONE state (Colorado) had a prevalence of obesity less than 20%.  Thirty-two states had a prevalence greater than 25%, and six of those states had a prevalence greater than 30%.  
• This is the first generation where the child's life expectancy is SHORTER than their parents.
• In 2000, obesity-related health care costs totaled an estimated $117 billion.

SO.  Take from that what you will... but this is more serious than people want to admit...!!  And after that educational moment on Thursday, I spent my day at clinical with a patient who is obese... spends 6-8 hours every day watching television, and refuses to participate in sports because she doesn't enjoy it.  It's a cycle -- kids aren't active, they get teased because they're overweight and unable to participate, and then they hide at home to escape the hurt and embarrassment they face at school.  It's terrible.  I tried to talk with the girl (13 years old) about her habits, but she wasn't really willing to listen.  I know it's tough for her... she comes from a broken home in East Baltimore, where it probably isn't very safe to be outside, with a mom who probably can't afford to buy healthier food (which is another community issue altogether), but hopefully she can find something to motivate her to be more actively involved in life.

Speaking of being active and eating healthy... I'm keeping up with my yoga practice, and I feel amazing.  I treated myself to some shopping in NYC at my favorite yoga store:  Lululemon Athletica.  I'm hoping to get a part-time job at one of the stores in Denver/SLC this summer.... keeping my fingers crossed!  I've also stuck with my "no sweets, no soda" pledge for the past 34 days -- SOOOO pleased with myself!  And what's even better, because I haven't had much sugar for the past month, it really doesn't sound appealing... maybe I should just keep this trend going... except for the dark chocolate of course (antioxidants, it's a healthy choice!) :]  Well, I have to get ready for my Saturday morning yoga session... Namaste!

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!

... could spring finally be here??

It's a beautiful Sunday afternoon here in Bal'mer... I just arrived home after a trip down to DC for church with a friend.  It was a much-needed break from the city -- sad to say that I was excited to be in a car driving on a freeway!  That says a lot about my life lately... Aside from my recent trip to New York with Greg, I haven't left the city of Baltimore for 2 months now.  I've forgotten what the world is like outside of my little bubble of Fells Point... thankfully the weather is finally starting to shift -- the sun is shining brilliantly on the harbor water today, with a bright blue sky overhead... could Spring finally be here??  I'm crossing my fingers, but definitely not holding my breath... Baltimore has found a way to disappoint me on more than one occasion in the past.  But I do have one thing to look forward to, that will happen whether Mother Nature wants it to or not -- DAYLIGHT SAVINGS TIME!  My favorite time of year... I don't care that I lose an hour of sleep, all that matters is that the sun will set after 7pm... I am so excited to walk home with some natural sun lighting up the sky! 

Well.  Because I have loads of studying and work to catch up on this evening, I'll try to keep this (somewhat) brief.  I've finished my second week in pediatrics, and it has been an interesting transition from Adult Health.  I've been assigned to work on the general med-surg floor for adolescents, and at Hopkins, "general" doesn't really encompass the breadth of medical cases that we see on our floor.  While I was working on the adult med-surg unit, we saw many local patients with common chronic diseases that they had been managing for many years -- namely COPD (chronic obstructive pulmonary disease), CHF (congestive heart failure), CKD (chronic kidney disease), DM (diabetes mellitus) and so on.  With the adolescent population, we are seeing families from all over the country, here at Hopkins as a "last resort" -- the hospitals back home are at a loss trying to diagnose and treat their ailments, so Hopkins is their only hope.  It can be a depressing situation, in that sense, because many patients do not know what is causing their problems, or if they do, it might not be something that can be treated at any regular hospital.  My first patient was from New Mexico, here to treat symptoms and complications from a rare genetic disorder that was only recently discovered (by her physician at Hopkins, no less) only 5 years ago.  She had spinal fusion surgery to correct her severe scoliosis, and had growing rods inserted to stabilize her back.  Her parents were present, and I cared for her over the course of my 12-hour shift.  We were happy to see her walking a bit by the time I was leaving, and she was such a trooper.  Thankfully her parents were very supportive and willing to assist with her rehabilitation, encouraging her to push through and do the activities that she did not want to do.  I think that's one of the most crucial factors in the health care of a child, whether the parents are willing to accept the diagnosis and comply with the course of treatment that their child needs, especially if it means pushing and challenging the child to do what he/she does not want to do.  As a nurse, my responsibility is to care for the child, but I am also "treating" the parents, by educating them and including them in the care of their child in preparation for discharge back home.  It's a delicate balance, and it will be interesting to see where the next 5 weeks take me....

And now for some exciting news:  This past Wednesday, I was fortunate enough to attend a lunch presentation by the Chief of Surgery for Johns Hopkins Hospital, Dr. Julie Freischlag.  Yes, a female Chief of Surgery.  It's an unfortunate rarity in this country, but she is managing the department quite successfully and spoke to us about taking on challenges when others say it isn't possible to succeed.  She was a fantastic speaker, and made some really interesting points that I greatly appreciated.  I was surprised to learn that she had completed her residency at UCLA, and that she had returned as the Director of Vascular Surgery at UCLA Medical Center for a few years before she moved to Baltimore.  I approached her after the presentation and thanked her for words of encouragement and inspiration, and to make a complicated story short, I asked her if it would be possible to observe one of her surgeries... and she was more than happy to arrange it!  So, next Monday over Spring Break, I will be in the OR... I'll be excited to report back details of my experience.

So, yes, Spring Break is next week... with the amount of school work I have looming on the horizon (between exams, assignments, projects, and presentations) I'm somewhat relieved that I won't be traveling anywhere.  It will give me some time to (hopefully) relax and check a few things off of my "To Do List."  I'm trying to plan a trip up to the Big Apple, at least for a few days... I don't mind the idea of traveling alone, and besides, I have friends to visit there and work that I can get done while I'm in the city.  And I will definitely appreciate the change of scenery!

With that, I'm going to leave you all... look forward to exciting updates on my next blog entry!!