'Twas the Night Before Christmas...

...And all through the house, not a creature was stirring, not even a mou-- HA. I wish!  I've learned that Charlie enjoys midnight romps through my room... and he loves to wake me up in the process.  I love the little guy though, and I'm going to miss him greatly when he relocates to sunny Malibu next week... yes, Charlie is moving back "home" to California to live with my mom until my schedule settles down a bit.  Work has been especially busy lately, as we wrap up the end of this year and prepare to "open" the Spine Center on January 3... I've been working 10-hr days at the clinic, and with my commute to Provo, I've been gone from 7 am to 7 pm Monday through Friday and poor Charlie is left cooped up in my room waiting ever-so-patiently for me to return.  He is the sweetest dog, and the best sidekick/friend I could have asked for... back when I was unemployed and single.  With all the recent changes in my life, though, my ability to care for him the way I would like to (and the way I know he deserves) has been greatly limited, and I realize that in order to do what is best for him I need to let him be somewhere he can have that attention that he needs.  It's been a really tough decision for me -- I feel somewhat irresponsible for bringing him into my life only to semi-abandon him just a few short months later.  But in my discussions with my mom and Jamison (my bf, in case you aren't aware), they have put my mind at ease -- I made this decision to adopt him when I had the time/energy to commit to his needs, but life changes ever-so quickly (and I am definitely familiar with that fact) and I never could have foreseen where I would be today.  Regardless of the current situation, I was able to rescue him from the shelter, and he will stay in a loving home that I know and trust -- which will also give me opportunity to visit him whenever I'm back in California.  I am just so grateful that my mom is willing to welcome little Charlie into her home -- I couldn't ask for a better surrogate "family" to care for him :)  And as much as Charlie loves the snow up here in Utah, I'm sure he will be happy to return to the warm California sunshine (whenever it decides to show its lovely face again)!

So.  Now on to more updates: WORK. I've been at the Spine Center for 2 months now, and I'm LOVING it!  Surprised?  I am.  After all my education and experience, and considering that I found my "niche" in Labor & Delivery, I did not expect to find a place for myself in Neurosurgery, working in an office M-F, 8-6.  But the job description matches my personality quite perfectly, and I feel that I have been able to contribute a great deal to the development of the Spine Center concept.  Currently, my main priority is to compile data and reports for the end of the month so that we can see where we need to focus our attention in January.  I've done quite a bit of patient triage and screening (my eventual central role at the clinic) in order to decrease the backlog of patients for the surgeons, but in order to get our system up-and-running come January, I've had to do a lot of data entry.  It's tedious work, but thankfully I have a great support system at the clinic and I love going to work each day.  I'll be grateful when all this prep work is completed, but we still have 3 more days at the clinic until the end of the month (and YEAR) so I just need to keep pushing forward.  I do see a light at the end of the tunnel, though... and that is what is keeping me motivated.  I am confident that my efforts will greatly improve the clinic's current practice, and I feel grateful to be a part of this new system!

HOLIDAYS.  Hard to believe that they are almost over... I always say that, but for some reason I've been more aware of it this year.   It feels like yesterday that I was celebrating Thanksgiving, and now here we are, getting the house ready for Santa to arrive... I love this time of year.  Especially in the shadows of the snow-capped Utah mountains, and especially with family and friends.  Last weekend I had the opportunity to travel to Idaho Falls with Jamison to meet his family (he is the youngest of 8 children) during their Christmas festivities.  I was slightly anxious about the whole situation (not sure how a Californian would fit in to an Idahoan family, especially because each of his siblings is married with children) but they welcomed me without any second thoughts and all my worries quickly disappeared.  I had such an enjoyable time -- brought me back to my childhood years and our epic Newman Reunions -- being one of 36 first-cousins was overwhelming, but I absolutely loved it.  So celebrating with his family was a pleasant surprise, and I couldn't have asked for anything more.  Is it too much to say that I love his family?  Shoot.  I do.  They are amazing, and I thank them for such a great "first" IF/Manwaring experience! I know what some of you Utahns may be thinking -- but NO, we are not engaged, and I don't see that happening any time soon.  Yes, we've been dating 3 months now, but we are perfectly content with our relationship and we don't feel the need to rush into any major decisions right now!  We are taking a road trip to California next week for New Year's and to visit Brenn and my adorable "niece" Blake, and that's what we are looking forward to.  That and springtime bike rides with Jamison on my new beach cruiser -- his gift to me for Christmas.  I AM IN LOVE.  With my bike, that is.  haha.  I cannot wait to ride around the city streets of Sugarhouse.... if only we could transport both of our bikes to California for a cruise down the Strand.... they are "BEACH cruisers" after all!   I'll have to put that on my list of "2011 Resolutions/Things to Do"  :)

Well, it is Christmas Eve (Day) and there are quite a few things to get done before that jolly old man makes his grand appearance, so I should get going.... I'll be back to update soon enough!  Until then, Merry Christmas and Happy New Year everyone!!  Much love to you all!

"seriously, so blessed!"

There is a hilarious blog that I occasionally read to brighten my mood... it's an exaggerated look at the life and times of a Utah housewife.  You really have no idea how RIGHT ON it is.  I die sometimes reading it... die laughing that is.  Here is a short clip:

I wish we could all be IRL besties you guys, bc seriously LOVE YOU, and if we were real life besties I would split a rio with a bunch of you and refill your diet any day, THEN hit the gateway for soooo many darling clothes that just SCREAM "us!!!" so loud we could NOT resIST and then whoopsies, overspend a smidge, end up hidding them from our hubbies until the credit card thingie comes, and then if JJWT or your hubby get's mad, we will cry and seriously bawl and then remind them of that one time they hurt our feelings real bad and then zinnnnng, the whole thing gets turned around on him and he'll end up apologizing his brains out and then I'll say, look, babenugget, I know you don't get it, I just need some girl time...

AND THEN WE JUST DO IT ALL OVER AGAIN!

LOVE my life!

 hahahahahaha.  Makes me grateful to live in Utah, just because of the pure entertainment value.

But now on to MY updates... I must admit, I am SERIOUSLY so blessed.  Great family, great friends, great boyfriend, great dog, great home, great job.....  YES, it has finally happened -- I have secured my first job as a nurse!  Not at all what I had expected, but it is turning out to be an incredibly pleasant surprise.  A friend down in Provo gave my information to a new office looking for RNs, and while I was driving back up to Salt Lake from Los Angeles (for another job interview) I received a phone call from the director of the center asking if I would come in for an interview the following day.  A couple meetings later, and after a few trial days of working in the office,
I am now the Nurse Care Coordinator for the Spine Center of Excellence in Provo.  The office has not yet opened, so this time is strictly dedicated to designing and organizing the most efficient and effective way to run our center.  We will be working in conjunction with the Utah Neurological Clinic and the 3 neurosurgeons there, who are well-known in the medical community.  Currently, the clinic has a 6-month backlog of patients waiting to see the doctors for diagnosis and treatment recommendations for pain related to the spine.  Records show that 80% of Americans will suffer back pain at some point in their lives, creating a large market for neurosurgeons specializing in this field... but with only 3,000 total neurosurgeons in the country, most are overwhelmed and understaffed to handle the demand.  Many patients wait months to be seen, and during that time, they are not treating the problem which can lead to worsening conditions and more severe symptoms.  Spine pain is not to be taken lightly, as it can lead to complete disability without proper care.  Many problems, however, can be treated with alternative non-surgical specialists (physical therapists, physiatrists, neurologists, radiologists, or pain management) and prolonging the diagnosis only delays the start of the appropriate course of treatment.  My primary responsibility will be to direct the patient pre-screening process through an online system, and then act as the connection between the patient and the physician before a first appointment is needed.  It's much more of an administrative nursing position than direct patient-care (as seen in a hospital) but I see great potential in the SCE's ability to provide quality patient care in a different way, touching the lives of many people and (hopefully) improving their overall quality of life.  I know it's going to be a bit of an unknown at first, as I am the first (and only) nurse working on this project at the center, but I am confident that once I get started and see how the system functions I will be able to make appropriate changes for things to operate more smoothly.  I have yet to meet the surgeons, but I have been scheduled to shadow their clinic days on Monday and Tuesday, and hopefully I will have the opportunity to watch some surgeries in the OR on Wednesday.  I know that this exposure will help to give more background on the patients' needs so that I will be able to better serve them.  My past experience at UCLA in athletic training is definitely coming in handy, but I know that I have much to review to feel more comfortable discussing conditions and treatment recommendations with these patients.  I'm quite surprised at how much I'm enjoying this aspect of nursing... I'd never considered the business or administrative side, but my personal strengths are very compatible with the job I've been asked to do, and I'm excited to see where this will take me (and what I'll learn along the way)!  On top of it, I really enjoy the office environment and the people I work with, so I am incredibly grateful for this opportunity.  I know there were many applicants for this position (they actually wanted to hire 2 nurses, but my boss has decided to wait and see if I am able to manage on my own for now) so I am extremely motivated to prove that I deserve this position and that I can handle the responsibility I have been entrusted with.  I'll be excited to share more as the weeks proceed, especially once we are up and running (hopefully) in a month.  The one downside is that I do have to commute about 30-45 minutes down to Provo (and it's PROVO... enemy territory...) but I can't complain about having weekends and holidays OFF!  How often does that happen in health care?!  And as a new graduate nurse... seriously. SO. blessed :)

I know the last post I made was while I was patiently waiting with Brenn for the arrival of her daughter, Blake, but my time in California was cut short when I heard back about a potential position at a hospital and I needed to return for an interview (which, as you may have figured, did not work out but of course everything happens for a reason...).  As of today, Brenn has not yet delivered her baby, putting her at almost 2 weeks of a very prolonged labor... my thoughts and prayers are with her during this difficult time of waiting.  Thankfully Blake is doing just fine -- I guess she is stubbornly refusing to take her place in the world... wish someone would tell her that her family is anxiously awaiting her arrival, and she will be one of the most loved little girls with two amazing parents completely prepared to care for her every need.  Her mom is aware that her "Auntie Lola" is ready to spoil her... I can't wait to meet the newest little Fergie :)

Hard to believe the holidays are right around the corner... but this is my absolute favorite time of year, especially because of the spirit that accompanies this special change in season.  I'm looking forward to having family in town next week for Thanksgiving, and for the early snowstorm we are expecting this weekend...!  I do love Utah snow, especially up in the mountains -- Snowbird opened today, and it's only a matter of time before Park City will be ready... Can't wait to strap on my board and cruise down through the fresh pow.  Oh how I missed being 20 minutes from the greatest snow on earth...!  And I'll definitely be making up for missing last year with my season pass this year... need I say more?  Okay, maybe :) seriously so BLESSED... blessed to live here in Salt Lake, and even more blessed that the Lord has provided me with an abundance of knowledge and opportunities to serve the people of this community.  Never saw this one coming, but that is the story of my life these days!  Guess I'll just continue to put my faith and trust in His plan for me, wherever that may lead me.........

Fall, Winter -- Summer?!

I had every intention of writing a new entry last week while I was enjoying the fall weather in Salt Lake City, watching the treetops change to beautiful shades of crimson and gold, and then covering our backyard in a yellow blanket of leaves... it was such a relaxing and enjoyable time.  I love the change of seasons, especially fall -- it's my favorite time of year.  Then, out of nowhere, it decided to SNOW.  Really?! In October?? A surprise "blizzard" created a VERY early winter wonderland, and it caught me completely off-guard.  Thankfully the snow melted over the next couple days, but regardless, I had plans to drive to Las Vegas for Halloween weekend with my boyfriend (yes, you did read that correctly) for his friend's wedding -- at the Little White Chapel no less -- and then on to California to help with Brenn's labor/delivery, so I knew I was going to escape the cold (at least for a week or so).

SO, currently I am enjoying the typical California fall weather -- 95 degrees at the BEACH. Whaat?!? That is definitely not normal.  But I'm not going to lie... I'm loving this last little bit of summer weather before I head back up to the truly winter weather in Utah.  But this trip is not exactly a vacation that I am able to "enjoy"... I'm sitting with Brenn after a short walk down the strand, who has now been in labor for 48 hours.  Poor thing... we're all so excited to meet little Blake, who is apparently completely content staying warm and cozy right where she is.  We head back to the hospital in a little while to see if she's made any further progress... bottom line, we are in need of some serious prayers everyone!  And in the spirit of Thanksgiving (it is November after all) I just want to say how grateful I am for the testimony and knowledge I have that everything happens for a reason -- whether it be this prolonged labor or the fact that I don't yet have a job to return to in Utah -- the Lord has a plan.  There are no mistakes or coincidences, only blessings that have not yet been revealed to us.  And with that, I'll be back to update in the next couple days, once there is something to update on... :)

breathe. just breathe.

It's Monday morning, and so begins yet another week as a member of the Day Club... I've been asking myself lately what I am meant to learn from this period of unemployment -- patience? gratitude? selflessness? For a person who truly enjoys being busy and having a regular schedule, this has REALLY been a struggle for me... my roommates say they're jealous, but I would trade this freedom for work in a heartbeat!  Thankfully having Charlie around has kept me occupied, but I worry that when I do start working, he is going to go through a serious period of separation anxiety.... he is SO spoiled right now!!  But I guess I should appreciate this time when I have "nothing" to do... and I'm trying to take advantage.  Like planning a spontaneous trip to NYC this week... one of my favorite places in the world, and definitely a great place to celebrate becoming a nurse :)

Unfortunately, the job hunt is proving to be much more difficult than I had ever anticipated... with the economy in a slump, hospitals have lost a lot of money, and are unable to hire "new graduate" nurses (like myself) because it is too expensive to train us.  It has been getting better over the last couple weeks, as I have noticed more job postings that "strongly prefer" rather than "require" previous hospital experience, but I have applied to 40+ jobs and I'm still waiting for some sort of response... I haven't given up hope though -- the Lord guided me here for some reason, and I have faith that something will present itself when the time is right.

In the meantime, I have been keeping busy by strengthening my resume -- I became a certified Phlebotomist (hoping to find a temporary job, but apparently I'm OVERqualified for those positions) and am currently taking an online Medical Spanish course.  I had intended to take a course to become a certified Doula (or Labor Support person) but I had conflicting appointments and was unable to attend.  I did get the course syllabus though, and I have been reading through it to keep my mind focused on nursing-related topics in the Labor & Delivery field... especially because in just a few short weeks, my dearest friend Brenn Ferguson will be giving birth to her first child (a daughter, Blake Marie) and I will be present for this special time in her life.  I feel so honored, and I am so grateful that I will be able to share this experience with her and her family.  I have complete faith in her, and know that she is going to be an amazing mother!!

The fall leaves are beginning to fall here in Salt Lake... quite late, actually, but I'm not complaining.  I enjoyed having an extra month of summer weather!  But I've pulled out my coats and sweaters, and I am happy to make this seasonal transition.  I'm planning to get my pass to Park City sometime in the next week... SO excited to be close to the mountains again!!  I only had a couple days on the slopes last winter, so I intend to take full advantage of my proximity to the BEST SNOW ON EARTH.  At least here we can make use of snow... I know I won't miss the snowmageddon days in Balmer last winter!  haha.  Well, I'm off to tackle another day of unemployment -- gotta keep busy in order to stay sane!  I'll be back next week with updates from my adventures in the city... until then, take care all!

Laura Newman, RN

 IT'S OFFICIAL!  

I found out this morning that I PASSED THE NCLEX (aka my nursing board exam)!!  I'm still in shock.  I might have to wait until this afternoon to write a more lengthy note because my head is spinning.... this is just so surreal.  I'm actually a NURSE!!!!!!!  Next step: find a job....

But for now, I'm relishing in the fact that I never have to take that horrid exam EVER. AGAIN.    SO, I'm going to go celebrate... Lululemon is opening their newest store in Salt Lake today (coincidence? hmmm...) and I'm going to treat myself to a little something special :)  And yoga this afternoon, of course.... despite the cloud-filled sky, I feel like it's going to be a BEAUTIFUL day!!!

aaaaaaaand.. I'M BACK!

Yes, it has been quite a long hiatus from my last post... but I was enjoying a much-needed "vacation" in California for the past month, and for some reason, R&R did not include pulling out my computer to update my blog.  But now that I have FINALLY returned to Salt Lake... I decided it's about time to share a few little details about my life as of late...

First and foremost, I need to bring attention to the fact that there has been a recent addition to "my" family......

.... meet CHARLIE!  I adopted him from an animal shelter in LA last week, and he is the perfect dog for me.  He is a 2-year-old Miniature Pinscher, and has been the greatest "best friend" I could ask for.  Such a great little personality, and I have had so much fun getting to know him!  He's been an outdoor dog, so I'm working on discipline and training, but thankfully he is house-broken.... no accidents in the house (yet.... *knock on wood*).  He's been my little shadow, but I'm slowly working on the socialization process and getting him used to being at home alone, in order to reduce his separation anxiety.  It's been an incredible learning experience for me, and I'm grateful for this opportunity to include the needs of another in my daily plans.  For so long I have only had to worry about my schedule and needs, and this is a completely new experience for me, and definitely one that I need to get used to!  He's very active, so I'm excited to explore the neighborhood with him on walks and, eventually, hikes in the canyons.  I've been looking forward to the day that I would have my own dog, and it was well-worth the long wait! :)

Aside from that exciting news, I am still studying and preparing to take the NCLEX (nursing boards) sometime within the next month.  The longer I sit and stare at my books, the more anxious I get, but I'm hoping (and praying) that this time studying will pay off.  Not that I have any job to rush off to... unfortunately I have been met with many dead-ends and "wait and see" responses, so I'm still on the hunt.  I don't want to let up my desire to work in maternal/newborn health care to find a position on a med/surg unit, so I'm going to find part-time work in a non-nursing related job until I find an opening somewhere.  I have faith that something will open up if I patiently wait.  In the midst of this search, however, I have made a very big decision: I plan to enter graduate school in June of next year!  Well, that is if I am accepted.  I know what I want to do, and I feel confident in my knowledge and skills to begin the road to my master's degree without spending another year working before I do so.  Besides, if I wait, who knows what life will throw at me, and will I really be able to start in a couple years?  I'd rather just start the program now and get it all over with, graduate, and be "Dr. NEWMAN" -- yes, it is a doctoral program.... so I will have my Doctorate in Nurse Practitioning (DNP) and I will be a Certified Nurse Midwife (CNM) after the 3-year program.  Meaning... I will graduate and FINALLY be done with school at the ripe YOUNG age of 30.... :)  haha.  I can't even believe it.... me?  30?!  But I know it is the best option for me, and I'm excited to get started!!  I have a meeting with the program director next week, so I'm crossing my fingers that things go well before I begin the application process.  As much as I try to plan, my life has proven to be quite unpredictable... so I've learned to roll with it, and I'm ready for this new direction my life has taken.  Trust in the Lord... that's all I have to do, and I know that it will all work out as planned :)

Without sharing all the "boring" details of my trip to California, I will say that I am SO grateful to be back on the West Coast!  I definitely belong out here, and I am so happy to be so "close" to my family and friends.  It was so great to see everyone and enjoy time basking in the sun on the beach....  but now I feel that I have been re-charged and given the extra boost I needed to kick-start my life here in Salt Lake.  So here goes nothing.......!!

HOME AT LAST!

It's Monday morning... I'm sitting in the comfort of MY bed at HOME here in Sugarhouse after a great weekend with my 3 new roommates (Aubree, Lori, and Amy).  We celebrated the Pioneer's holiday by throwing a housewarming party (complete with a delicious S'mores bar) and we were grateful for the many friends and family that showed up to visit. 

Because I feel somewhat disconnected from my life as a nursing student, finally able to sit back and ENJOY summer, I'm going to refrain from providing excessive details of the final weeks in Denver... looking back at my time at UCH in the Women's Care Center, I really feel grateful for the opportunity I had to learn and grow with the diverse range of experiences I was exposed to while there.  It was a challenge, but it solidified my desire to pursue work in this field -- I know without a doubt that I have been called to be a Midwife.  But I'm still trying to process the past 14 months -- did it all really happen?  Did I move 2,000 miles away from family and friends?  Did I survive the rigors of one of the most prestigious, competitive, and intensely accelerated nursing programs in the country?  Did I actually GRADUATE from JOHNS HOPKINS UNIVERSITY with my third BS this past Friday?!?!  I think I've really outdone myself this time... to the point of not believing it could all be possible.  But once my diploma arrives in the mail, it will really hit me -- I DID IT.  I am now an NURSE!  Well, unlicensed, but still... I've worked so hard to get to this point, and I am SO excited to finally start this career that I've waited so long for.  I just have to get past my NCLEX (board exam) at the end of August....

As of now, I have plans(/hopes) to work as a nurse for the next year, and by next fall, I'm hoping to work on my application to the University of Utah's graduate nursing program -- dual degree as a Certified Nurse Midwife (CNM) and a Women's Health Nurse Practictioner (DNP).  We'll see what this next year holds in store for me, but whatever is thrown my way, I know I'll be ready for it....  I have a quote on my nightstand that reminds me:

"Believe in yourself and all that you are.  Know that there is something inside you that is greater than any obstacle." - Christian D. Larson

And for family/friends who are in Southern California, I'm coming "HOME" this Thursday -- can't wait to see you all!  The Pacific Ocean is calling my name....

While you were sleeping...

Darkness has enveloped the city of Denver, and for most people that indicates time to prepare for sleep.  Well… my body isn’t quite sure what to make of ‘time’ anymore, especially the meaning of daylight hours.  I worked last night, and I remember watching the sun rise and light up the unit, which was the signal that our shift was nearing its end and I was almost free to go home.  Rather than preparing for a new day to begin, I was reflecting on the night’s adventures and processing all that had happened – I still cannot believe all the chaos we dealt with!  Although I’ve had some crazy nights over the past couple weeks (I’ll share some highlights later), nothing quite compared to the madness of last night.  And I feel it’s only fair to share my experience with you…

07/12/10 @ 1715 (5:15 pm for those not familiar with the 24-hour clock): I roll out of bed after a 3-hour nap hoping that I’ve had enough rest to carry me through the night (my FRS natural energy drink helps a bit too).  I throw on my work attire - navy blue scrubs - and gather my supplies (and my brain) for one of the few remaining shifts I have on the WCC unit here in Denver...

1750: Driving on the freeway to the hospital, I get caught in rush hour traffic – people heading HOME after a long day at work.  To think that my night had only just begun…

1820: Walking on to the unit, I take one look at the board to find 4 out of our 5 birthing rooms occupied, with 2 patients in active labor (meaning they are past 4 cm dilation).  The rest of our inpatient rooms (14 antepartum/postpartum and 1 PACU) were nearly full, and we had 2 patients in triage (with 5 triage rooms available).  I knew then it was going to be busy, but I had no idea what the night would turn into…

1845: I get my patient assignment, and find out that we are slightly short-staffed, so I will be managing this labor patient mostly on my own (!!) with Miriam, checking in occasionally to see if I am managing okay.  I learned that my patient was G3/P2, meaning this was her third pregnancy and that she had 2 additional children (one who wanted to be at the hospital with her mom and dad).  I was not too worried – ‘multips’ (as we call those women who have had 2 or more pregnancies/deliveries) usually know their bodies well enough to tell us when they are ready, and know how to push (one of the primary factors that affects the delivery process, and usually the most difficult thing for women to figure out how to do).  We anticipate that once these patients 'go', they are able to deliver a baby smoothly and quickly.  Yes, we were treating my patient for severe pre-eclampsia, but nothing else stood out as being a major factor for a complicated delivery (we deal with pre-eclamptics quite often, and it is serious, but we are well-equipped to manage these patients).  The best treatment for these patients is delivery, so it’s common to induce/augment the labor process if the contraction pattern is not regular enough to cause any change in the cervix.  We received the order from the doctor to start Pitocin (the synthetic form of the natural labor-inducing hormone) and turned the IV drip on at 1 mU/hour (the smallest dose possible).  I will say, I am NOT a fan of Pit… yes, there are situations that it is more-or-less necessary (as with my patient) but many physicians/hospitals exploit the ‘benefits’ of Pit – namely, that they can schedule deliveries.  If a doctor wants to deliver a baby faster, they’ll turn up the Pit.  Well, that’s all fine and dandy – unless you consider the stress it puts on the baby.  Every time the uterus contracts, pressure is put on both the baby and the placenta, which decreases the amount of blood/oxygen flowing to the baby.  If the contractions occur too frequently (hypertonicity) and baby isn’t getting enough oxygen, the fetal heart rate (FHR) drops… and when the monotonous sound of the rapid heartbeat emitted from the monitor slows from 130 to 80, it sets off alarms in our heads to react.  This doesn’t always happen with Pit, but it is definitely a ‘common’ adverse effect that we must be prepared to deal with.  So, we started my patient on Pit, and watched her progress from the central monitors in the nurses’ station.   

1950: A nurse calls an L&D ‘code’ for an antepartum patient, who was pregnant with twins at only 30 weeks.  Her twins had been diagnosed with “Twin-to-Twin Transfusion,” meaning one infant was receiving more of the placenta’s blood supply than the other (a high risk for infant mortality).  She was also a Jehovah’s Witness, so refused any transfusions during her pregnancy to promote development in the smaller twin.  The ‘code’ was called for the smaller baby, when the FHR dropped to the 60s – and stayed there.  The doctors rushed in, checked the ultrasound tracing, and confirmed that the baby was not getting enough oxygen = CRASH C/S.  The team raced back to the OR for delivery, and en route, our charge nurse nearly ruptures her Achilles’ tendon – no joke.  I guess in her efforts to push the bed back to the OR, she turned too quickly around a corner and heard a dreaded ‘POP’ and then found herself in the ER for the next couple hours (after the C/S of course).  What a trooper… especially when she came back up and wheeled around in her classy hospital wheelchair in order to manage the floor. 

2000: I return to my patient’s room to do her hourly ‘Mag check’ (an IV med she’s on for the pre-eclampsia) and my preceptor insists that I turn up the Pitocin.  “We want to deliver this baby!” she says… and I understand that delivery is important for women with Pre-E, but she’s not showing any major concerning signs of the diagnosis. I know my preceptor is slightly more aggressive with Pitocin titration, so I expressed my desire to hold off a little while longer, but I work under her license… so we turned up the Pit by 2 mU/hr. 

2115: One of the laboring patients feels the urge to push… some of the staff returning from the OR dash into the room to deliver baby #3 for the evening, leaving the nursing station virtually empty.  I wandered into the room to see if any help was needed, and one of the nurses asks me to check in on a patient next door who is paging.  I walk in to deal with Cinderella’s stepmother and two stepsisters – a teenage ‘primip’ (1^st pregnancy) lounging on the labor bed, expecting to be waited on hand-and-foot while she is in ‘labor’ – I’m sorry darling, a cervix that is “cl/thk/H” (closed – thick – high) is NOT considered labor, regardless of your seemingly-regular contractions – asks me to clean up a spot of blood on the base of the bed.  Okay, I understand in normal circumstances this would be something I would take slightly more seriously (it should have been cleaned better) but in comparison to the events taking place just 30 feet away, I almost wanted to hand her a paper towel to clean it up herself.  But of course the Cinderella inside me smiled, grabbed a Cavi-Wipe (hospital-grade Clorox wipe) and cleaned up the small reminder of a previous delivery.  Apparently, the rest of the night she paged every 5 minutes because she felt as though HER needs (including ice water, which is accessible to family members) were priority #1. 

2130: I return to my patient’s room to check in on her progress (our new intern, now in her 3^rd week of her residency program) comes with me to do another cervical exam.  “Great news – she’s complete!  Her bag is bulging, and we should probably AROM her so we can have this baby.”  Artificially rupture her membranes?  I understand this does speed up the process, in most situations… but is it really necessary?  My preceptor and I are both on the same page.  But in this hierarchical chain of command, the doctor’s decision trumps our intuition, even if she is only in her 3^rd week of her residency (meaning that she just graduated to receive her MD less than a couple months ago).  The attending physician approves, and soon enough, the patient is one step closer to having her baby.  Miriam and I stay close to monitor baby, and the pushing begins.   Because the patient has her epidural, she can’t feel her contractions, so we have to ‘coach’ her as she pushes to ensure that she pushes with the contractions, and that she’s focusing her efforts on the right area (which she can’t feel).  I understand that comfort is ideal, but this is LABOR! It is not meant to be cushy and relaxing… even if the anesthesiologists market their services to offer that experience.

2220: After nearly 30 minutes of pushing with little progress, unusual for a gravida 3 patient, the repetitive sound of baby’s heart beat disappears from the monitor.  I jump in to move the monitor and throw a pulse-ox on the patient’s finger to distinguish mom’s heart rate from baby’s, and find that the situation is much worse than we expected – mom’s heart rate has jumped to 120, and baby’s has dropped to the mid 80s-low 90s.  NO BUENO.  Delivery needs to happen, and it needs to happen NOW.  Lucky for us, the chief is close by – even though this is his FIRST NIGHT working at our hospital (he had just completed his residency in Ohio) he scrubs in to help our attending and intern.  “FORCEPS!” He yells.  One of the nurses races down the hall to grab the sterile ‘birthing spoons’ used to help deliver baby’s head in such emergent situations.  Just 20 minutes later, a healthy baby girl is born screaming her little head off – it was almost as if she was laughing, like she had played some practical joke on us to scare us all into thinking she was tanking.  Her APGARs of 9 and 9 are indicative of a healthy baby, and the NICU team (who are always present for forceps-assisted deliveries) chuckle as they swaddle this ‘perfect’ little infant.

0015: We get a call that a patient is being flown in from Boulder, with complaints of regular contractions and bleeding – and she’s only at 27 weeks.  We prepare the room, alert NICU, and wait for her arrival.

0045: A patient checks in, and we look at her numbers – G10/P0905.  Yes, she’s on her 10^th pregnancy, but all 9 previous babies were born pre-term (before 34 weeks) and only 5 survived.  Patients with 6+ pregnancies are considered ‘grand multips’ and we definitely worry about precipitate delivery (labor onset à delivery less than 3 hours) with these unique patients.  She’s at 28 weeks, however, and that means yet ANOTHER preterm infant.  She rattles off her complex OB history (including 6 cesareans), and we all look at each other stunned that our shift is only ½ over… and wonder if this is the rain starting to pour…

0100: I return to my patient’s room for her routine Mag check, and notice that her blood pressures are spiking upwards of 170s/100s – a BAD sign for any patient, but especially for those with the diagnosis of pre-eclampsia.  I get the information to the doctor, and she orders a stat dose of Labetelol to be given IV.  My preceptor returns with me and we administer the med, and I complete my assessment.  Thankfully, she doesn’t have any other complaints or worrisome signs/symptoms, so we watch the monitors closely and see her BP return to her baseline, offering reassurance that we avoided a possible eclamptic seizure. 

0130: A patient returns from a 2-hour ‘walk’ (we send patients to walk through the hospital if they are in earlier stages of labor and don’t want to admit them just yet) and is vomiting at the front desk.  The triage nurse brings her back to one of the rooms, and has her lie down… just a few minutes later, we hear her shout “I can see baby’s head!  We are delivering in Triage C!”  As if we haven’t had enough exercise running through the halls of our unit this evening, we rush to help.  The triage rooms are quite small, so only a handful of people can actually fit, so we wait outside for instruction.  Shortly thereafter, screams are heard (not from baby) indicating that the patient is very close to delivery.  I can only imagine what the other triage patients were thinking… but it’s the reality of the situation they’re all in, and I’m sure many of them contemplated the idea of an epidural at that moment. 

0220:  Triage C baby is doing well, and we look to the board to see all of our triage rooms full, with 2 patients in very active stages of labor.  Our crippled charge nurse calls upstairs to the ‘Birth Center’ (the low-risk labor & delivery unit) to see if they can take some of our less-complicated patients.  They are short-staffed as well, but we are able to send 2 of our patients up for their deliveries. 

0245:  We learn that the transfer patient from Boulder is not going to deliver… yes, she did rupture, and yes, she is at risk for pre-term delivery, but thankfully her baby has decided to stay inside for a little while longer.  Despite all the medical interventions we can implement, in the end, nature does take over – mom’s body is the best (and only) determining factor that can predict what will happen.

0400: I return to check on my patient, finally resting comfortably in the peace and quiet of her postpartum room with her 5-hour-old infant in the basonette at her bedside, and her husband and 7-year-old daughter asleep on the couch, and offer a small prayer of thanks that this little Hispanic family was so patient with me as I did my best to care for them throughout the frenzy of the night.

0430: The chaos finally subsided (I didn’t even mention the incidents with a couple of the postpartum patients who were being managed for hemorrhages they had suffered during their deliveries the day before).  We gathered together in the nurse’s station to process and debrief the events of the previous 10 hours.  We finally found time to laugh at our charge nurse, who had attempted to hobble in to Triage C on crutches to help with the delivery, and listened as the nurse caring for stepsister A joked about some of her ridiculous demands throughout shift.  With another 2 hours to go, we all PRAYED that nothing else would disturb this rare silence… (thankfully for us, our prayers were answered)

0630: I returned to my patient’s room before I left the floor to offer my ‘best wishes’ and ‘congratulations’, and her sincere response of “Gracias” made (most) memories of the night dissolve… oh, wait, did I mention she only spoke Spanish? HA. But in all seriousness, despite crazy nights like these, I am SO grateful for this position that I have been called to – I have the unique opportunity to be a part of this momentous occasion in each of these patients’ lives.  It might be just another night of work to me… but I constantly remind myself of one of my favorite quotes:

“To the world you may be just one person, but to one person, you just may be the world.”

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.... =]

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…..